Lessons Learned from Patients with Grossen Steinstrassen
Experience with 19 patients (25 ureters) who suffered the complication of grossen steinstrassen (≧ one-third of ureteral length) has led to lessons regarding the management of this complication as well as to insights into patient presentation, metabolic consequences, and the efficiency of diagnostic and therapeutic modalities. Very few symptoms were present in a large percentage of patients despite urinary obstruction, decreased renal function, infection, and in several cases, impending sepsis. Large stone burdens, bilateral treatments, inability to debulk stone burden prior to extracorporeal shock wave lithotripsy (ESWL*) and unexpected fragment movement were predisposing factors in the development of this complication. Double-pigtail stents and percutaneous nephrostomy did not always prevent or resolve the problem. Combined use of percutaneous nephrostomy (PCN) and ureteroscopic ultrasonic/laser lithotripsy appears to be the most effective treatment modality in those patients who fail to pass the stone material following a period of brief observation. This approach can be combined under appropriate circumstances with a secondary ESWL or percutaneous nephrolithotripsy treatment in the staged management of complex upper urinary tract calculous disease.
KeywordsShock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Renal Colic Ureteral Stents Serum Creatinine Elevation
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