Current Management Concepts in the Treatment of Ureteral Stones
Since ureteral stones have been included in the range of stones routinely treated by ESWL, controversy as to whether ESWL should be done in situ or whether it should be preceded by ureteral stone manipulation has occurred. In this regard, we have noticed a continental division, reflecting the peculiarities of the differences in health care systems in Europe and the United States. In the U.S., most physicians prefer retrograde stone manipulation with or without the use of ureteral stents. Ureteral stone manipulation is performed in order to reposition the stone into the renal collecting system. A stent is commonly used to bypass the stone and to create an artificial expansion chamber.
At UCLA we pursue a differentiated approach which is as follows: Based on the radiographic appearance of an existing natural expansion chamber, approximately 10% of stones above the iliac crest and 25% of stones located in the pelvic window (that is, in the true pelvis, below the pelvic brim), are eligible for ESWL in situ treatment. All other stones, which do not qualify for in situ treatment, undergo ureteral stone manipulation, utilizing stents and extensive ureteral lubrication. This differential approach has advantages over our previously described combined approach, in that it does not change the success rate (97%) and overall hospital stay (1.2 days), but it does save ureteral manipulation for approximately 30% of patients. Stones which cannot be manipulated, cases of failed ESWL treatment, and persistent steinstrasse are treated with ureteroscopy.
KeywordsExtracorporeal Shock Wave Lithotripsy Ureteral Stone Stone Removal Ureteral Stents Ureteral Calculus
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