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Progress in Management of Ureteric Stones

Authors
Journal
EAU Update Series
1570-9124
Publisher
Elsevier
Publication Date
Volume
3
Issue
1
Identifiers
DOI: 10.1016/j.euus.2004.08.004
Keywords
  • Urinary Calculi
  • Ureteroscopy
  • Shockwave Lithotripsy
  • Drug Therapy
  • Ureterolithotomy
Disciplines
  • Computer Science
  • Medicine

Abstract

Abstract Most symptomatic urinary stones are found within the ureter. Depending on stone localisation and size, a substantial portion is able to pass the upper urinary tract spontaneously. This process may take days to weeks and the patient has to receive sufficient analgetic and spasmolytic medication. There is some evidence, that alpha-adrenoreceptor blockade supports expulsion of praevesical stones. Standard and least invasive treatment for ureteric stones is extracorporeal shockwave lithotripsy (SWL). However, stone free rate after SWL of ureteric stones after single SWL is lower than for kidney stones and many patients require more than one shockwave application. Recent developments in ureteroscopy (URS) like small-calibre scopes and Ho:YAG laser lithotripsy have changed treatment algorithms as URS is highly efficient, has lower costs than SWL and is still minimally invasive. Especially for larger stones (>10 mm), URS seems to have advantages compared to SWL. Today, open or laparoscopic ureterolithotomy are reserved for special indications and are not used routinely. In summary, SWL offers minimal-invasiveness but a higher risk of treatment failure compared to URS which reaches immediate high stone free rates. Treatment decisions have to be drawn individually taking into account patients preference, personal experience and local equipment.

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