The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study
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We compared the outcomes of SWL to treat distal ureter stones with regard to the conventional prone and supine positions using the transgluteal approach through the greater sciatic foramen.
A prospective, randomized, single-blind, and multicenter study was conducted between October 2014 and July 2015. The inclusion criteria were radio-opaque distal ureter stones with a maximum diameter of 0.5−2 cm as measured on a CT scan. The included 160 patients were randomly assigned to two groups: the prone group (n = 80; treated in the conventional prone position) and the transgluteal group (n = 80; treated in the supine position using a transgluteal approach). In the latter group, the focused shock wave was transmitted through the greater sciatic foramen with the head positioned at a 40° angle to the vertical. “Stone-free” was defined as the complete clearance of stone fragments, assessed using a CT scan at 2 weeks after treatment. Overall satisfaction was self-reported using a 0–5 Likert scale.
The overall efficacy was 66.9%. The stone-free rate was significantly higher in the transgluteal group (72.6%) than in the prone group (54.7%; odds ratio 2.413, 95% CI 1.010−5.761, P = 0.023). No serious adverse events due to treatment were observed in either group. The satisfaction score of the transgluteal group was 4.21 ± 0.81, and 83.6% were willing to repeat the same procedure if necessary.
SWL using the transgluteal approach via a supine position through the greater sciatic foramen was more effective than via the conventional prone position. Furthermore, this approach provided a comparably safe and satisfactory procedure.
KeywordsLithotripsy Patient positioning Prone position Supine position Ureteral calculi Treatment outcome
MSC and SHL designed and organized this prospective multicenter study; MSC and JHH summarized and analyzed the multicenter data and wrote the manuscript; JKK, TYS, WKL and SKL were the clinicians who enrolled participants and performed the shockwave lithotripsy procedures on the distal ureter stones and recorded the data at each center.
This research was supported by Hallym University Research Fund 2015(HURF-2015-27).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
This study was conducted according to the principles of the Declaration of Helsinki.
Human and animal rights
Clinical Research involving Human Participants but no Animals.
The written informed consent form was signed by each participant.
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