Augmentation of the success of extracorporeal shock wave lithotripsy for upper ureteral calculi after manipulation

Abstract

Objective: To assess the efficacy of in situ ESWL in the treatment of neglected, long-standing upper ureteral calculi and to study whether or not manipulation and stenting followed by ESWL augments the success rate. Patients and Methods: The study involves 54 solitar t upper ureteral stones, first treated in situ. Unresponsive stones were pushed back into the renal pelvis and the collecting system was stented, catheterized before subjecting the patients to ESWL again. Plain X-ray was done not earlier than 10 days after treatment to assess the stone status. Results: Of the 54 stones, 36 (66.6 %) could be fragmented successfully with in situ ESWL. The remaining 18 were manipulated before another session of ESWL. Success for treatment of upper ureteral calculi was augmented from 66.6% after in situ ESWL to 96.2% after manipulating those 33.4% stones unresponsive to in situ ESWL. Although larger calculi (>1.6 cm) required manipulation, they were fragmented with exposure to lesser number of shock waves. Conclusion: In situ ESWL is effective in stones 1.6 cm are better treated by ESWL after manipulation and stenting catheterization, as these are less likely to fragment in situ.

Keywords

• Extracorporeal Shock Wave Lithotripsy; Upper Ureteral Calculi; Manipulated Calculi.