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Two Years Clinical Experiences with Extracorporeal Shock-Wave Lithotripsy and Transurethral Ureterolithotripsy for Ureteral Stones at Osaka City University Hospital

1989; Elsevier BV; Volume: 16; Issue: 5 Linguagem: Inglês

10.1159/000471613

1873-7560

Taketoshi Kishimoto, Keisuke Yamamoto, Toshikado Sugimoto, Kazunobu Sugimura, Tatsuya Nakatani, Seiji Wada, Sinichi Ikemoto, Muneki Umori, M Senju, Toshinao Kanazawa, Masanobu Maekawa,

Biomedical Research and Pathophysiology

From July 1985 to June 1987, 303 patients with ureteral stones were treated by either extracorporeal shock-wave lithotripsy (ESWL) or transurethral ureterolithotripsy (TUL). The ureteral stones were classified into two groups, upper and lower ureteral stones. The upper ureteral stone was defined as a stone located above the pelvic brim in radiological examinations. ESWL was performed using a Domier lithotriptor HM-3. For TUL, following the insertion of a guide wire and dilatation of the intramural ureter by ureteral bougie, a ureteroscope was introduced into the ureter. The success rate included both patients who became stone free and patients whose stones were disintegrated into less than 4 mm. The success rate of ESWL for upper ureteral stones was 90%, and 8.5% were treated subsequently by TUL. The success rate of TUL for upper ureteral stones was 42 %, and the remaining required another session of TUL or another procedure, mainly ESWL. On the other hand, the success rate of TUL for lower ureteral stones was 71 %, and the remainder also required another session of TUL or another procedure, mainly ESWL. The efficacy of TUL for stone street was comparably low by the evaluation done at 5 days after the procedure. However, almost all patients with stone street, which had developed after ESWL treatment, became stone free several weeks after TUL and insertion of a stent catheter. Major complications or side effects for ESWL were fever of more than 37.5 °C (7.5%) and pain attacks (8.9%). Those for TUL were fever of more than 37.5 °C (80%) and ureteral perforation in 6 of 98 procedures. Only 1 case required open surgery because of complete rupture, and indwelling of a stent catheter was effective in 4 cases. The average number of hospitalization days after treatment was 5 for ESWL and 8.4 for TUL.