Transurethral ureterolithotomy in 100 lower ureteral stones.
A total of 100 patients with lower ureter stones received transurethral ureterolithotripsy (TUL) using a pulsed dye laser and/or a pneumatic lithotriptor. Extracorporeal shock wave lithotripsy treatment was added in 15 patients because fragments larger than 4 mm had been pushed back to the renal pelvis. The median stone size was 8 mm (range 3-22 mm). Operative time ranged between 3 and 157 min with a median of 30 min. Stone size correlated well with impaction, when impaction was defined as the inability of a guidewire to pass over the stone. Complete removal was defined as total clearance at 1 month without retreatment. The overall stone-free rate was 93%. Among the 7 not-stone-free cases, 5 cases were considered to have been treated successfully because asymptomatic residual fragments were smaller than 4 mm, 1 case required retreatment to become stone free, and 1 case with a silent residual fragment of 8 mm had been followed up for 3 months. The success rate was 98% when successful treatment was defined as total clearance or the presence of asymptomatic residual fragments of 4 mm or less without retreatment. Impaction was not a significant determining factor of stone-free rate (95.7 and 86.7%, respectively, p > 0.05) and in situ stone-free rate (TUL alone; 85.7 and 76.7%, respectively, p > 0.05). Two minor ureteral perforations were encountered. No patient required percutaneous nephrostomy or open surgery, or showed any late complications. TUL is a safe and successful method in managing lower ureteral stones.
Hamano
S
S
Department of Urology, Asahi General Hospital, Chiba, Japan.
Tanaka
M
M
Suzuki
N
N
Shiomi
K
K
Igarashi
T
T
Murakami
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000737:chemistry / Q000175:diagnosis / Q000628:therapy*