title: Pneumatic lithotripsy for large ureteral stones: is it the first line treatment?
abstract: OBJECTIVE
  To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones.
  
  
  METHODS
  We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%) were treated primarily with PL and 115 (73.7%) were treated secondarily after unsuccessful extracorporeal shock wave lithotripsy (SWL). The mean stone diameter was 12.87 mm (range 10-20.5 mm). Results were evaluated 3 months after treatment by excretory urography and/or ultrasonography.
  
  
  RESULTS
  The overall stone-free and fragmentation rates (FRs) were 85.2 and 92.3%, respectively. Corresponding values were 60 and 84% for upper ureteral stones, 79.5 and 89.7% for middle ureter stones and 94.5 and 95.6% for lower ureteral stones, respectively. The main complications were migration of a complete stone or of fragments (7.1%), urosepsis (4.5%) and ureteral perforation (1.3%).
  
  
  CONCLUSIONS
  Although SWL is generally accepted as the first treatment option for ureteral stones because of its non-invasive nature, PL with ureteroscopy seems to be a good alternative with the advantage of higher success rates and quick stone clearance. Especially when we take the importance of quick stone removal into account for larger ureteral stones, which are more likely to have obstruction, impaction, or infection, we believe that PL may be chosen as the first line treatment rather than SWL for stones larger than 10 mm.
authors.affiliation: Urology, gazi university, cukurambar mah. 38. cad. 3/21, Balgat, Ankara, 06520, Turkey. ltunc@gazi.edu.tr
authors.forename: Lutfi
authors.initials: L
authors.lastname: Tunc
authors.forename: Bora
authors.initials: B
authors.lastname: Kupeli
authors.forename: Cagri
authors.initials: C
authors.lastname: Senocak
authors.forename: Turgut
authors.initials: T
authors.lastname: Alkibay
authors.forename: Sinan
authors.initials: S
authors.lastname: Sözen
authors.forename: Ustunol
authors.initials: U
authors.lastname: Karaoglan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bozkirli
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy; D014546:Urinary Catheterization