UJ 35 Summer.pdf 557Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L 1Private Medicabil Hospi- tal, Bursa, Turkey 2Department of Urol- ogy, Acibadem University School of Medicine, Bursa, Turkey 3Department of Urology, Afyon Kocatepe University School of Medicine, Afyon- karahisar, Turkey 4ACK Urotas Shock Wave Lithotripsy Center, Bursa, Turkey Murat Demirbas,1 Murat Samli,2 Mustafa Karalar,3 Ahmet C. Kose4 Extracorporeal Shockwave Lithotripsy for Ureteral Stones Twelve years of Experience with 2836 Patients at a Single Center Corresponding Author: Murat Demirbas, MD FSM Bulvari Aksel Sitesi A Blok D.10 İhsaniye- Nilüfer, Bursa, Turkey Tel: +90 532 236 4838 Fax: +90 224 247 6630 E-mail: muratdemirbas@ doctor.com Received September 2011 Accepted February 2012 Purpose: Materials and Methods: - - spontaneous passage of the stone. Results: P = .257). The success rates for individuals respectively (P P = .09). Conclusion: Our retrospective evaluation of this large patient series reveals that SWL is effective for treating stones in the proximal, mid, and distal ureter. Keywords: ENDOUROLOGY AND STONE DISEASE 558 | INTRODUCTION The prevalence of urolithiasis is estimated to range -nary system stones are in the ureters.(1) The various treatment options for ureteral stones include extracorporeal - copy, and open surgical ureterolithotomy. Laparoscopy and open ureterolithotomy are rarely used to remove these stones, (2) have made it an important treatment modality for urinary tract (3) MATERIALS AND METHODS - - - derlying infection. - cluded age, gender, stone location, stone size, number of - culated rates of SWL success (stone-free status after SWL - tation after three SWL sessions or no spontaneous passage of patients overall and for various subgroups. - - not used routinely to detect the presence of minute stone frag- ments, due to concerns about the amount of radiation dose - ment of the patient.(4) - by spontaneous passage.(5) - - - - - peridine). - - (6) (7) The Endourology and Stone Disease 559Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L reached. - - - sessions or retained fragmented stones after one month of - gery. stone location (proximal, mid, and distal ureter) and stone t - and subgroups. P RESULTS (range, 15 to 74 years). The mean maximum stone length and mm (range, 2 to 14 mm), respectively. Eight hundred and - than in the right ureter (1530 versus 1306, respectively; P = (range, 110 to 13500). became stone-free after a maximum of three SWL treatments. - categorized according to demographic characteristics and stone parameters. Maximum stone dimension, mean number - the failure group (P < .001 for all). self-limiting hematuria, dysuria, and pain that responded to oral analgesics. P = .257). The success rate for patients P - P = .371). - P - tively (P = .09). - spectively; P - P DISCUSSION Since the initial attempt at extracorporeal lithotripsy by the optimal approach for managing ureteral stones remains Shockwave Lithotripsy for Ureteral Stones | Demirbas et al 560 | controversial. Guideline published by the European Asso- - ureterolithotomy are rarely used in these cases. Such tech- (2) According to the guideline mentioned above, there is no ureteral stones.(2) (2) the distal ureter, and several have documented success rates above 90% for this patients group.(9,10) - (9) - proximal, mid, and distal ureteral stones, respectively.(2) associates documented for proximal, mid, and distal ureteral used for treating mid and distal ureteral stones.(10) The modi- - tor in our success.(6) A common problem during SWL, particularly in patients imaging due to intestinal gas. When such gas is present, it is - mg four times a day before the procedure to ensure clear im- Endourology and Stone Disease Results for the successful and failed shockwave lithotripsy groups with the 2836 total patients categorized according to demographic characteristics and various stone parameters. Successful (stone-free) Failed (Surgery) P Gender Male 1842 (74.7%) 268 (72.4%) .371 Female 624 (25.3%) 102 (27.6%) Mean age, y 40.4 ± 12.5 42.66 ± 12.13 .003 Stone location Proximal ureter 742 (85.1%) 129 (14.8%) .257Mid-ureter 262 (83.9%) 50 (16%) Distal ureter 1462 (88.4%) 191 (11.5%) Side affected Right 1117 (85.5%) 189 (14.4%) .039 Left 1349 (88.1%) 181 (11.8%) Stone size and location in ureter Proximal stones ≤ 10 mm 526 (90%) 58 (10%) < .001 Proximal stones > 10 mm 216 (75.3%) 71 (24.7%) Mid-ureter stones ≤ 10 mm 158 (85.8%) 26 (14.2%) Mid-ureter stones > 10 mm 104 (81.3%) 24 (18.7%) Distal stones ≤ 10 mm 1160 (90.4%) 123 (9.6%) Distal stones > 10 mm 302 (81.6%) 68 (18.4%) Mean maximum stone dimension (range), mm 9.5 ± 2.66 (5 to 15) 10.86 ± 2.56 (5 to 15) < .001 Mean no. of shockwaves (range) 3084.06 ± 1866.46 (110 to 13400) 5186.92 ± 2404.22 (800 to 13700) < .001 561Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L The other main problem during SWL is that many patients administered diclofenac 75 mg orally or intramuscularly diclofenac analgesia. Previous reports have indicated that an- (11-13) - of SWL success in older patients. larger stones, higher numbers of SWL sessions, and larger - - - (2) CONCLUSION Our retrospective evaluation of this large patient series re- veals that SWL is effective for treating stones in the proxi- mal, mid, and distal ureter. We believe that experience of the - sition, effective analgesia during SWL, and administration of simethicone before each session are all important factors in the success of this therapy. Although advances continue to be made in endourologic surgery, SWL remains an appropriate treatment option for stones of 5- to 15-mm diameter in any location along the ureter, and yields good success. CONFLICT OF INTEREST None declared. REFERENCES 1. Resit-Goren M, Dirim A, Ilteris-Tekin M, Ozkardes H. Time to stone clearance for ureteral stones treated with extracor- poreal shock wave lithotripsy. Urology. 2011;78:26-30. 2. Türk C, Knoll T, Petrik A, Sarika K, Straub M, Seitz C. Guide- lines on urolithiasis EAU. http://www.uroweb.org/gls/ pdf/18_Urolithiasis.pdf; 2011. 3. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2:1265-8. 4. Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;363:1-4. 5. Smith RD, Shah M, Patel A. Recent advances in manage- ment of ureteral calculi. F1000 Med Rep. 2009;1:1-53. 6. Kose AC, Demirbas M. The 'modified prone position': a new approach for treating pre-vesical stones with extracorpor- eal shock wave lithotripsy. BJU Int. 2004;93:369-73. 7. Rassweiler JJ, Knoll T, Kohrmann KU, et al. Shock wave tech- nology and application: an update. Eur Urol. 2011;59:784- 96. 8. Chaussy C, Eisenberger F, Forssmann B. Extracorporeal shockwave lithotripsy (ESWL): a chronology. J Endourol. 2007;21:1249-53. 9. Demirbas M, Kose AC, Samli M, Guler C, Kara T, Karalar M. 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Shockwave Lithotripsy for Ureteral Stones | Demirbas et al