Einstein (São Paulo) (Sep 2006)
Critical analysis of treatment options for proximal ureteral calculus
Abstract
Ureteral lithiasis is a prevalent problem that may cause painful renalcolic. When interventions are necessary, various techniques may beemployed. Endourological techniques and minimally invasive proceduresare the preferred options to treat lithiasis and they dramatically reducedindications for open conventional ureterolithotomy. The most recentguidelines for treating urinary stones, published in 1997 and based on ameta-analysis of literature data, recommends extracorporeal shockwavelithotripsy as the first option to treat most ureteral calculi. Afterthe publication of this guideline, some studies presented excellent resultsusing narrower endourological instruments, laser energy source, andlaparoscopic ureterolithotomy. These publications support the use ofthe techniques to treat ureteral stones, which will probably be includedin the next updated guideline. Particularly for proximal ureteral calculi,the results of extracorporeal shock-wave lithotripsy and endourologicaltechniques have been inferior when compared to other ureteralsegments, mainly when stones are larger than 10mm. The newapproaches and studies demonstrated better results than those publishedin the 1997 guidelines, which may be altered in relation to treatment ofproximal ureteral stones. This review assesses the results of currentoptions to treat proximal calculi and suggests a treatment algorithm.
