Extracorporeal shock-wave lithotripsy of middle ureteral stones: Are ureteral stents necessary?

Stephen Y. Nakada, Margaret S Pearle, Jon J. Soble, Stephanie M. Gardner, Bruce L. McClennan, Ralph V. Clayman

Research output: Contribution to journalArticle

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Abstract

Objectives: To ascertain whether insertion of a ureteral stent improves the outcome of middle ureteral (overlying the pelvic bone) stones treated with extracorporeal shock-wave lithotripsy (ESWL). Methods: Thirty-three patients with middle ureteral stones were treated with ESWL at our institution between October 1991 and October 1994. Twenty-six patients were available for follow-up; 14 patients were treated with stent bypass, 8 were treated in situ, and 4 patients were treated after percutaneous nephrostomy (PCN). All patients were treated initially on an unmodified Dornier HM-3, and all but 4 patients were treated in the prone position on a modified Stryker frame. Follow-up consisted of a plain abdominal radiograph, intravenous urogram, occasionally a retrograde urogram, and a telephone interview. Results: The overall stone-free rate for ESWL alone was 73%, and the efficiency quotient was 69. The stonefree rates after a single treatment for the stent bypass, in situ, and PCN groups were 71%, 63%, and 75%, respectively. Overall, 4% of patients required retreatment, 19% of patients required an auxiliary procedure, and 8% of the patients required hospital or emergency room admissions for renal colic. For stones 10 mm or greater (9), stone-free rates after one treatment for the stent bypass, in situ, and PCN groups were 33%, 33%, and 67%, respectively; for stones less than 10 mm (17), success rates were 82%, 80%, and 100%, respectively. Conclusions: Pretreatment stinting provides no advantage over in situ ESWL for middle ureteral calculi (Fisher's exact test, P = 1.0). ESWL is a reasonable initial therapy for middle ureteral stones less than 10 mm.

Original languageEnglish (US)
Pages (from-to)649-652
Number of pages4
JournalUrology
Volume46
Issue number5
DOIs
StatePublished - 1995

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Lithotripsy
Stents
Shock
Percutaneous Nephrostomy
Urography
Pelvic Bones
Ureteral Calculi
Renal Colic
Prone Position
Retreatment
Hospital Emergency Service
Therapeutics
Interviews

ASJC Scopus subject areas

  • Urology

Cite this

Extracorporeal shock-wave lithotripsy of middle ureteral stones : Are ureteral stents necessary? / Nakada, Stephen Y.; Pearle, Margaret S; Soble, Jon J.; Gardner, Stephanie M.; McClennan, Bruce L.; Clayman, Ralph V.

In: Urology, Vol. 46, No. 5, 1995, p. 649-652.

Research output: Contribution to journalArticle

Nakada, Stephen Y. ; Pearle, Margaret S ; Soble, Jon J. ; Gardner, Stephanie M. ; McClennan, Bruce L. ; Clayman, Ralph V. / Extracorporeal shock-wave lithotripsy of middle ureteral stones : Are ureteral stents necessary?. In: Urology. 1995 ; Vol. 46, No. 5. pp. 649-652.
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title = "Extracorporeal shock-wave lithotripsy of middle ureteral stones: Are ureteral stents necessary?",
abstract = "Objectives: To ascertain whether insertion of a ureteral stent improves the outcome of middle ureteral (overlying the pelvic bone) stones treated with extracorporeal shock-wave lithotripsy (ESWL). Methods: Thirty-three patients with middle ureteral stones were treated with ESWL at our institution between October 1991 and October 1994. Twenty-six patients were available for follow-up; 14 patients were treated with stent bypass, 8 were treated in situ, and 4 patients were treated after percutaneous nephrostomy (PCN). All patients were treated initially on an unmodified Dornier HM-3, and all but 4 patients were treated in the prone position on a modified Stryker frame. Follow-up consisted of a plain abdominal radiograph, intravenous urogram, occasionally a retrograde urogram, and a telephone interview. Results: The overall stone-free rate for ESWL alone was 73{\%}, and the efficiency quotient was 69. The stonefree rates after a single treatment for the stent bypass, in situ, and PCN groups were 71{\%}, 63{\%}, and 75{\%}, respectively. Overall, 4{\%} of patients required retreatment, 19{\%} of patients required an auxiliary procedure, and 8{\%} of the patients required hospital or emergency room admissions for renal colic. For stones 10 mm or greater (9), stone-free rates after one treatment for the stent bypass, in situ, and PCN groups were 33{\%}, 33{\%}, and 67{\%}, respectively; for stones less than 10 mm (17), success rates were 82{\%}, 80{\%}, and 100{\%}, respectively. Conclusions: Pretreatment stinting provides no advantage over in situ ESWL for middle ureteral calculi (Fisher's exact test, P = 1.0). ESWL is a reasonable initial therapy for middle ureteral stones less than 10 mm.",
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AU - Gardner, Stephanie M.

AU - McClennan, Bruce L.

AU - Clayman, Ralph V.

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N2 - Objectives: To ascertain whether insertion of a ureteral stent improves the outcome of middle ureteral (overlying the pelvic bone) stones treated with extracorporeal shock-wave lithotripsy (ESWL). Methods: Thirty-three patients with middle ureteral stones were treated with ESWL at our institution between October 1991 and October 1994. Twenty-six patients were available for follow-up; 14 patients were treated with stent bypass, 8 were treated in situ, and 4 patients were treated after percutaneous nephrostomy (PCN). All patients were treated initially on an unmodified Dornier HM-3, and all but 4 patients were treated in the prone position on a modified Stryker frame. Follow-up consisted of a plain abdominal radiograph, intravenous urogram, occasionally a retrograde urogram, and a telephone interview. Results: The overall stone-free rate for ESWL alone was 73%, and the efficiency quotient was 69. The stonefree rates after a single treatment for the stent bypass, in situ, and PCN groups were 71%, 63%, and 75%, respectively. Overall, 4% of patients required retreatment, 19% of patients required an auxiliary procedure, and 8% of the patients required hospital or emergency room admissions for renal colic. For stones 10 mm or greater (9), stone-free rates after one treatment for the stent bypass, in situ, and PCN groups were 33%, 33%, and 67%, respectively; for stones less than 10 mm (17), success rates were 82%, 80%, and 100%, respectively. Conclusions: Pretreatment stinting provides no advantage over in situ ESWL for middle ureteral calculi (Fisher's exact test, P = 1.0). ESWL is a reasonable initial therapy for middle ureteral stones less than 10 mm.

AB - Objectives: To ascertain whether insertion of a ureteral stent improves the outcome of middle ureteral (overlying the pelvic bone) stones treated with extracorporeal shock-wave lithotripsy (ESWL). Methods: Thirty-three patients with middle ureteral stones were treated with ESWL at our institution between October 1991 and October 1994. Twenty-six patients were available for follow-up; 14 patients were treated with stent bypass, 8 were treated in situ, and 4 patients were treated after percutaneous nephrostomy (PCN). All patients were treated initially on an unmodified Dornier HM-3, and all but 4 patients were treated in the prone position on a modified Stryker frame. Follow-up consisted of a plain abdominal radiograph, intravenous urogram, occasionally a retrograde urogram, and a telephone interview. Results: The overall stone-free rate for ESWL alone was 73%, and the efficiency quotient was 69. The stonefree rates after a single treatment for the stent bypass, in situ, and PCN groups were 71%, 63%, and 75%, respectively. Overall, 4% of patients required retreatment, 19% of patients required an auxiliary procedure, and 8% of the patients required hospital or emergency room admissions for renal colic. For stones 10 mm or greater (9), stone-free rates after one treatment for the stent bypass, in situ, and PCN groups were 33%, 33%, and 67%, respectively; for stones less than 10 mm (17), success rates were 82%, 80%, and 100%, respectively. Conclusions: Pretreatment stinting provides no advantage over in situ ESWL for middle ureteral calculi (Fisher's exact test, P = 1.0). ESWL is a reasonable initial therapy for middle ureteral stones less than 10 mm.

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