What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review

PURPOSE OF REVIEW Shock wave lithotripsy is the treatment of choice for small renal and upper ureteric stones. This review examines the factors that improve fragmentation and clearance of stones, and recent advances in this area. RECENT FINDINGS Several randomized trials published recently have demonstrated the role of tamsulosin in helping the clearance of ureteric fragments after shock wave lithotripsy. The role of slow shock wave delivery rate has been well established. Percussion, diuresis and inversion have been used to improve results in lower calyceal stones. Few clinical studies have explored the role of position during treatment. The effects of progressive increase of lithotripter output have been demonstrated only in experimental studies. SUMMARY Tamsulosin can be used to increase clearance, and reduce episodes of ureteric colic and the need for analgesics after shock wave lithotripsy. Shock waves at slow rate improve both the safety and efficacy of shock wave lithotripsy. Percussion, diuresis and inversion augments clearance of lower calyceal fragments.

Optimizing the fragmentation and clearance after shock wave lithotripsy.

We compared the outcomes of SWL to treat distal ureter stones with regard to the conventional prone and supine positions using the transgluteal approach through the greater sciatic foramen. A prospective, randomized, single-blind, and multicenter study was conducted between October 2014 and July 2015. The inclusion criteria were radio-opaque distal ureter stones with a maximum diameter of 0.5−2 cm as measured on a CT scan. The included 160 patients were randomly assigned to two groups: the prone group (n = 80; treated in the conventional prone position) and the transgluteal group (n = 80; treated in the supine position using a transgluteal approach). In the latter group, the focused shock wave was transmitted through the greater sciatic foramen with the head positioned at a 40° angle to the vertical. “Stone-free” was defined as the complete clearance of stone fragments, assessed using a CT scan at 2 weeks after treatment. Overall satisfaction was self-reported using a 0–5 Likert scale. The overall efficacy was 66.9%. The stone-free rate was significantly higher in the transgluteal group (72.6%) than in the prone group (54.7%; odds ratio 2.413, 95% CI 1.010−5.761, P = 0.023). No serious adverse events due to treatment were observed in either group. The satisfaction score of the transgluteal group was 4.21 ± 0.81, and 83.6% were willing to repeat the same procedure if necessary. SWL using the transgluteal approach via a supine position through the greater sciatic foramen was more effective than via the conventional prone position. Furthermore, this approach provided a comparably safe and satisfactory procedure.

The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study

To evaluate the efficacy of company-initiated training of urologists on shock wave lithotripsy (SWL) treatment results, we retrospectively assessed 602 patients who underwent SWL in Nagoya City University Hospital between January 2004 and June 2011 using Lithotripter S (Dornier MedTech, Japan). Training—provided by a training specialist of the company in June 2010—focused on the targeting of renal and proximal ureter stones with a combination of radiography and ultrasonography (US). The stretcher wedges were positioned in the semi-prone position or the semi-supine position for middle and distal ureter stones, respectively. Success rates between 519 pre-training treatments and 83 post-training treatments were compared. Patient age and stone location, burden, number, and composition did not significantly differ between pre- and post-training. Training improved the overall success rate from 66.3 to 87.2 % (P < 0.0001). The mean number of SWL treatments decreased from 1.8 ± 1.8 to 1.4 ± 1.3 (P = 0.01). The first SWL treatment success rate increased from 67.1 to 83.7 % (P = 0.002), and the need for multiple treatments decreased. The frequency of detection of renal and proximal ureter stones by both radiography and US increased from 10.5 % before training to 58.2 % after training (P < 0.0001). Significant factors for successful SWL were determined to be training and prone position for distal ureter stones by multivariate analysis and ultrasonic detection for renal and proximal ureter stones by univariate analysis. Skills in targeting stones using ultrasonography and selecting the proper therapeutic position are essential for improving the success rate of stone removal.

Impact of official technical training for urologists on the efficacy of shock wave lithotripsy

Shock Wave Lithotripsy (SWL) has become the preferred first-line approach to most patients with symptomatic urolithiasis. The purpose of this study is to assess the ideal patient position during SWL for the treatment of distal ureter stones. A total of 342 patients included in this retrospective study. 148 (108 men, 40 women) patients were included in the first group and were treated in supine position. The remaining 194 (143 men, 51 women) patients were included to second group and were treated in prone position. This study designed retrospectively. The procedure was accepted as a success if the patient was stone free or had only clinically insignificant fragments (≤3 mm) for 3 months or more after the last SWL session. Before SWL, the mean is one area in the first group was 61.32 mm2 while the mean stone area in the second group was 59.04 mm2 (p = 0.208). Mean energy, Mean energy maximum and mean number of applied shock waves of the first group was 4.65, 3.19 and 3,960, respectively. The same parameters in second group were 4.26, 3.03 and 2,953, respectively. These results show that there are statistically significant differences between two groups with respect to mean energy, mean energy maximum and mean number of applied shock waves (p = 0.003, p = 0.010, p = 0.000, respectively). Success rate was 85.1% in group 1 and 72.7% in group 2 (p = 0.006). Our results suggest that supine position is effective and better than prone position for SWL in patients with distal ureteric stones.

Shock wave lithotripsy for distal ureteric stones: supin or prone

Introduction: The aim of this study was to evaluate the treatment of upper ureteral calculi with extracorporeal shock wave lithotripsy (SWL) in the supine and prone positions. Materials and Methods: A total of 68 patients with upper ureteral calculi underwent SWL. In 35 patients, the procedure was performed in the supine position (group 1), while in the 33 remainders, it was performed in the prone position (group 2). The stone-free rate, the number of SWL sessions required, and the number of shocks per treatment session were compared between the 2 groups. Results: The mean calculus size was 12.4 Â± 3.1 mm and 12.2 Â± 2.9Â mm in groups 1 and 2, respectively. The stone-free rate was 81.8% in group 1 and 82.9% in group 2 ( P = .91). The number of sessions for achieving the stone-free status was similar in the patients of the 2 groups (1.9 Â± 0.8 in group 1 versus 1.9 Â± 0.8 in group 2; P = .79). The meanÂ number of shock waves per treatment session was not significantly different between the 2 groups. No major complications were seen and none of the patients required hospitalization, placement of a ureteral catheter, or a double-J stent. Conclusion: Our study showed that in the prone position, treatment of the upper ureteral calculi by SWL is as safe and effective as the supine position.

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Extracorporeal Shock Wave Lithotripsy in Prone and Supine Positions for Patients with Upper Ureteral Calculi

The aim of this study was to determine whether positioning of the patient, prone or supine, plays a significant role on the treatment of stones in the proximal ureter with extracorporeal shock wave lithotripsy (ESWL). 68 patients with proximal ureteric stones underwent ESWL. The procedure was performed in the supine position in 35 (Group 1) and the prone position in 33 patients (Group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. The mean session number per patient was 1.93 ± 0.82 in Group 1 and 1.88 ± 0.79 in Group 2 (P = 0.786). The stone-free rates, three months after ESWL, were 81.8% in Group 1 and 82.9% in Group 2 (P = > 0.05). Thus, these two parameters were similar in both Groups. Also, the number of shocks per session was 3066.1 ± 346.3 in Group 1 and 3148.5 ± 621.0 in Group 2. This difference was nonsignificant (P = 0.49). Our study suggests that the treatment of proximal ureteric stones with ESWL in the prone position is as safe and effective as when the patient is placed in the supine position.

Comparison of the Effect of Body Position, Prone or Supine, on the Result of Extracorpreal Shock Wave Lithotripsy in Patients with Stones in the Proximal Ureter

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Extracorporeal Shock Wave Lithotripsy in Prone and Supine Positions for Patients with Upper Ureteral Calculi

Comparison of the Effect of Body Position, Prone or Supine, on the Result of Extracorpreal Shock Wave Lithotripsy in Patients with Stones in the Proximal Ureter