Extracorporeal shock wave lithotripsy of ureteral calculi

Article Abstract:

Until recently, treatment for stones in the ureter, the tube connecting the kidney and the bladder, was limited to either close observation to see if the stone passed on its own, manipulating it with a scope to get it to pass, or surgery. New treatments include dissolving the stone with shock waves (extracorporeal shock wave lithotripsy, or ESWL) and using a ureteroscope to manipulate and remove the stone. ESWL is preferred when the stone is in the upper third of the ureter, while the ureteroscope is usually used when the stone is in the lower third of the ureter. ESWL is most effective when the stone is surrounded by fluid (i.e. urine). This can be accomplished by passing a catheter past the blocked area or by pushing the stone into the kidneys. In the January 1990 issue of Radiology, Barr et al. report that ESWL can be highly successful, even when the catheter cannot be passed through the blockage and treatment with a ureteroscope fails. These researchers used a higher number of shock waves than is normally used. The ureteroscope is more successful in treating stones when the stones are more distal (lower). The instrument used is rigid and it is difficult to manipulate it beyond a certain point in the ureter. When it is used, the stone is caught in a basket and then removed or destroyed. Success in using this technique is highly dependent upon the skill of the technician using the scope. The more problematic situation is where the stone cannot be removed with the ureteroscope nor can it be pushed into the kidney. Although the study by Barr reported success with repeated ESWL treatments, it did not mention whether repeated ureteroscopic treatments were attempted. Once the ureteroscope reaches the stone, repeat treatments are rarely required, unlike ESWL. The Barr study certainly indicates that ESWL is useful as a secondary treatment for stones that cannot be reached with a ureteroscope or a catheter, but this situation involves only a small population of the patients with these stones. Ureteroscopic extraction of stones from distal regions, and the middle regions if they can be reached, of the ureter is still preferable to ESWL. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Hysteroscopy

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In situ lithotripsy of ureteral calculi: review of 261 cases

Article Abstract:

The ureter is the tube that allows passage of urine from the kidneys to the bladder. It can become blocked by stones. Treatment to remove such stones varies, depending on the location of the stones. If the stones are lodged toward the lower end of the ureter, they can usually be removed directly with a ureteroscope. On the other hand, if they are in the upper third of the ureter, shock wave lithotripsy, fragmentation of the stones with shock waves, is normally used. Such stones are usually pushed with a catheter back into the kidneys prior to lithotripsy, as stones that are bathed in urine or other fluids respond much better to the procedure. The more difficult situation is where the stones can neither be reached with a ureteroscope nor pushed back into the kidneys. This study reported on the treatment of ureter stones with lithotripsy where the stones initially could not be manipulated with either a ureteroscope for direct removal nor with a catheter to push the stones into the kidneys. Lithotripsy was used to treat 261 stones that did not respond to initial manipulations and remained in place in the ureter. Fragmentation was successfully achieved for 254 (97 percent) of the stones, with 219 (86 percent) successfully fragmented with only one lithotripsy treatment. Thirty more cases were successful after two treatments and five cases were successful after three treatments. Retrograde catheters were in place when the lithotripsy was performed on 215 (82 percent) patients. Neither the presence nor the placement of these catheters affected treatment outcomes. In 81 cases, some type of intervention was required following lithotripsy to help remove the stones. These results indicate that lithotripsy can be highly successful in treating ureteral stones that cannot be manipulated by other means. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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Balloon dilation of the prostate: effective treatment or dilatory tactic?

Article Abstract:

Benign prostatic hyperplasia (BPH), or noncancerous enlargement of the prostate, afflicts a large percentage of men at some time in their lives. The common treatment is prostatectomy, the surgical removal of all or part of the prostate, usually by means of an incision through the urethra. This surgery is very common and represents a significant amount of health care spending in this country. This treatment has a successful record but recent data have shown long-term results to be less spectacular, while its costs are high. This has led to increased interest into less expensive, noninvasive techniques. One of these techniques is transurethral balloon dilation (TUDP). This technique involves inserting a balloon into the urethra and inflating it. Research has shown this technique to be inexpensive, simple, and safe. A question still remains regarding the effectiveness of this technique. An article by Wasserman et al. in the February 1991 issue of Radiology reports TUDP to be effective. There are problems with this research, however, that may invalidate the results. The lack of controls in the study prevents examination of a placebo effect; urine flow is not necessarily an accurate measure of bladder obstruction; the subjects were not followed-up for a long enough period to see in TUDP had a merely transitory effect; and finally, the results do not agree closely to other research results in this area. The results may be encouraging, but further research using controls is needed to establish that TUDP is an effective treatment for BPH. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Balloon dilatation, Prostate, Prostatic hyperplasia, Prostatectomy, Transurethral, Transurethral prostatectomy

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