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Is Pre-Shock Wave Lithotripsy Stenting Necessary for Ureteral Stones With Moderate or Severe Hydronephrosis?

Authors :
Ahmed R. El-Nahas
Khaled Z. Sheir
Ahmed El-Assmy
Source :
Journal of Urology. 176:2059-2062
Publication Year :
2006
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2006.

Abstract

We performed a prospective, randomized clinical trial to evaluate the outcome of ureteral stents for solitary ureteral stones 2 cm or less in moderately or severely obstructed systems using shock wave lithotripsy.Between 2001 and 2004, 186 patients who met study criteria were randomized into 2 groups. Group 1 received a pre-shock wave lithotripsy 6Fr Double-J stent and group 2 had no stent. Patients were treated with a Dornier MFL 5000 lithotripter. Results were compared in terms of clearance rates, number of shock waves and sessions, irritative voiding symptoms, incidence of complications and secondary interventions. Failure was defined as the need for additional procedure(s) for stone extraction.Overall 164 patients (88.2%) became stone-free after shock wave lithotripsy. Complete stone fragmentation was achieved after 1 to 3 and more than 3 session in 108 (58.1%), 30 (16.1%), 13 (7%) and 14 patients (7.5%), respectively. Ureteral stent insertion did not affect the stone-free rate, which was 84.9% and 91.4% in groups 1 and 2, respectively (p = 0.25). There was no statistical difference in the re-treatment rate, flank pain or temperature in the 2 groups. However, all patients in the stented group significantly complained of side effects attributable to the stent, including dysuria, suprapubic pain, hematuria, pyuria and positive urinary culture.Pretreatment stenting provides no advantage over in situ shock wave lithotripsy for significantly obstructing ureteral calculi. Shock wave lithotripsy is reasonable initial therapy for ureteral stones 2 cm or less that cause moderate or severe hydronephrosis.

Details

ISSN :
15273792 and 00225347
Volume :
176
Database :
OpenAIRE
Journal :
Journal of Urology
Accession number :
edsair.doi.dedup.....54065f80ec097f5e9aed61613f3890d9
Full Text :
https://doi.org/10.1016/j.juro.2006.07.022