The influence of lithotripsy methods on the incidence of auxiliary procedures after ureteric stone desintegration

• Published in: Vojnosanitetski pregled Vol. 65; no. 8; pp. 619 - 625
• Main Authors: Radulovic, Slobodan, Vuksanovic, Aleksandar, Milenkovic-Petronic, Dragica, Vavic, Bozo
• Format: Journal Article
• Language: English
• Published: Military Health Department, Ministry of Defance, Serbia 2008
• Subjects: lithotripsy; methods; outcome; treatment; urolithiasis
• ISSN: 0042-8450; 2406-0720
• DOI: 10.2298/VSP0808619R

Introduction/Aim. Localization of ureteric stones and the difference in disintegration success are the most important but not the only factors in choosing the first treatment approach to ureteric stones. The aim of the study was to investigate the incidence of auxiliary procedures after different ureteric stones lithotripsy modalities. Methods. In a prospective bicentric study 260 patients with ureteric stones were analyzed. The patients were divided into two groups: group I - 120 patients subjected to extracorporeal shock ware lithotripsy (ESWL) treatment and group II - 140 patients treated endoscopicly with ballistic lithotripsy using "Swiss" Lithoclast. Results. Endoscopic treatment of all distal ureteric stones was significantly more successful than ESWL, but not significantly more successful than ESWL regarding proximal ureteric stones except for stones larger than 100 mm2 that were significantly better treated with endoscopic method. There was no general significant difference in auxiliary procedures rate after lithotripsy between the two groups. In the group I auxiliary procedures were significantly more performed than in the group II after the lithotripsy of stones larger than 100 mm2, calcium-oxalat-monohydrate stones and highly significantly more performed after the treatment of stones located in the iliac ureteric portion and impacted stones. After the lithotripsy of lumbar ureteric stones and multiple stones situated in different ureteric portions additional procedures were highly significantly more necessary in the goup II than in the group I. Conclusion. Being significantly more successful comparing to ESWL, ureteric stone treatment with "Swiss" Lithoclast should be considered the first therapeutic option for all, especially impacted stones located in iliac and pelvic ureter. In spite of a statistically significant difference in success rate, ESWL should be performed as the first treatment option in all cases of lumbar stones as well as multiple stones located in different ureteric portion because of lower auxiliary procedures rate except for stones larger than 100 mm2 that should be primarily treated endoscopicly. . Uvod/Cilj. Lokalizacija kamena i razlika u efikasnosti dezintegracije najvazniji su, ali ne i jedini faktor u izboru primarnog terapijskog pristupa kod prisustva kamena u ureteru. Cilj rada bio je da se ispita ucestalost primene dodatnih intervencija nakon razlicitih metoda dezintegracije kamena u ureteru. Metode. Prospektivnom bicentarskom studijom obuhvaceno je 260 bolesnika sa kamenom u ureteru, podeljenih u dve grupe: grupa I - 120 bolesnika lecenih elektrokorporalnom udarnotalasnom litotripsijom (ESWL) i grupa II - 140 bolesnika tretiranih endoskopski "Swiss" Lithoclastom. Rezultati. Dezintegracija kamena distalnog dela uretera bila je visoko statisticki znacajno uspesnija primenom endoskopske metode nego primenom ESWL, dok nije bilo statisticki znacajne razlike u broju uspesno dezintegrisanih kamenova proksimalnog uretera izmedju dve metode, osim kamena krupnijeg od 100 mm2 koji je statisticki znacajno efikasnije tretiran endoskopski. Nije bilo statisticki znacajne razlike u primeni dodatnih intervencija nakon sprovedenog lecenja izmedju dve grupe bolesnika. U grupi I dodatne intervencije bile su statisticki znacajno cesce izvodjene nakon tretmana kamena kalcijum-oksalat-monohidratnog sastava i krupnog kamena, a statisticki visoko znacajno cesce nakon tretmana kamena ilijacnog dela uretera i inklavisanog kamena. U grupi II dodatne intervencije bile su visoko statisticki znacajno cesce nakon tretmana lumbalnih i multiplih kamenova lociranih u razlicitim segmentima uretera. Zakljucak. Imajuci u vidu efikasnost dezintegracije i ucestalost primene dodatnih intervencija, endoskopska metoda moze se smatrati primarnim vidom terapije svakog, a pogotovu inklavisanog kamena distalnog dela uretera, kao i kamena lumbalnog uretera krupnijeg od 100 mm2. Zbog redjeg izvodjenja dodatnih intervencija ESWL moze se smatrati primarnom opcijom lecenja u slucaju prisustva kamena u lumbalnom ureteru, osim ako nije krupniji od 100 mm2. .