title: Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones.
abstract: OBJECTIVE
  To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm.
  
  
  METHODS
  This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia.
  
  
  RESULTS
  The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required.
  
  
  CONCLUSIONS
  ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.
authors.affiliation: Department of Urology, Al-Thawrah Modern General Hospital and Ibn-Siena Hospital, Sana'a Medical College, Sana'a University, Yemen.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Telha
authors.affiliation: Department of Urology, Al-Thawrah Modern General Hospital and Ibn-Siena Hospital, Sana'a Medical College, Sana'a University, Yemen.
authors.forename: Khaled
authors.initials: K
authors.lastname: Alkohlany
authors.affiliation: Department of Urology, Al-Thawrah Modern General Hospital and Ibn-Siena Hospital, Sana'a Medical College, Sana'a University, Yemen.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alnono
keywords: AUR, acute urinary retention; Bladder stone; ESWL; ESWL, extracorporeal shockwave lithotripsy; KUB, plain abdominal radiograph of the kidneys, ureters and bladder; Monotherapy; US, ultrasonography; Urethral stone