title: Primary ureteroscopy for distal-ureteral stones compared with ureteroscopy after failed extracorporeal lithotripsy.
abstract: OBJECTIVE
  We reviewed our experiences with ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of distal-ureteral stones and investigated whether failed extracorporeal shockwave lithotripsy (SWL) is a limiting factor for the ureteroscopic procedure.
  
  
  METHODS
  We retrospectively studied the medical records of 375 patients treated with URS-PL from January 1999 to September 2005 in our clinic. Of these patients, 213 were treated with URS-PL primarily (group 1), whereas the remaining 162 patients had undergone SWL unsuccessfully before URS-PL was performed (group 2). We used 9F or 9.5F rigid instruments and the Vibrolith (Elmed, Ankara, Turkey).
  
  
  RESULTS
  In group 1, 206 patients (96.7%) were treated successfully with URS alone, as were 155 patients (95.6%) in group 2. Impacted stones were observed in 21 patients in group 1 (9.85%) and in 57 patients in group 2 (35.1%). The average operating time was 33.19 +/- 9.039 minutes in group 1 and 57.42 +/- 8.757 minutes in group 2. The stone-free rates of the two groups were significantly different on the first postoperative day, but this difference decreased to an insignificant level at the end of the first month.
  
  
  CONCLUSIONS
  When SWL fails, URS-PL is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be effective for impacted stones.
authors.affiliation: Department of Urology, Baklrkoy Training and Research Hospital, Istanbul, Turkey. volkantugcu@yahoo.com
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
authors.forename: Gokhan
authors.initials: G
authors.lastname: Gürbüz
authors.forename: Bekir
authors.initials: B
authors.lastname: Aras
authors.forename: Levent
authors.initials: L
authors.lastname: Gurkan
authors.forename: Alper
authors.initials: A
authors.lastname: Otunctemur
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Tasci
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000150:complications / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*