doiSerbia

Influence of lithotripsy modalities on complication rate

Radulović Slobodan (Kliničko odeljenje urologije, Kliničko-bolnički centar 'Zvezdara', Beograd)
Milenković-Petronić Dragica (Institut za urologiju i nefrologiju, Klinički centar Srbije, Beograd)
Vuksanović Aleksandar (Institut za urologiju i nefrologiju, Klinički centar Srbije, Beograd)
Vavić Božo (Kliničko odeljenje urologije, Kliničko-bolnički centar 'Zvezdara', Beograd)

Introduction. Localization of ureteric stones and difference in disintegration success are the most important factors in determining the first treatment approach for ureteric stones. Objective. The aim of our study was to evaluate the difference in complication rate between different ureteric stone lithotripsy modalities. Methods. Two hundred sixty patients with ureteric stones were analyzed in a prospective bicentric study that lasted 1 year. The patients were divided into two groups: I - 120 patients who underwent ESWL (extracorporeal shockwave lithotripsy) treatment and II - 140 patients who were treated endoscopically with ballistic lithotripsy. Results. Ureteroscopic lithotripsy of all pelvic and iliac stones was significantly more successful comparing to ESWL, while lumbar ureteric stone treatment with ureteroscopic lithotripsy was not significantly more successful than ESWL, except for lumbar stones larger than 100mm2 that were significantly better treated endoscopically. In the I group complications after lithotripsy were recorded in 64 (59.3%) and in the II group in 58 (42.0%) patients, meaning that complications were statistically significantly more frequent in the I than in the II group. In the II group complications were significantly more often recorded after treatment of proximal comparing to ureteric stones of other localizations, while in the I group complications were significantly more often detected after treatment of impacted stones than in the II group. Conclusion. Being significantly successful comparing to ESWL, ureteric stone treatment with ureteroscopic lithotripsy should be considered as the first therapeutic option for all, especially impacted stones located in the iliac and pelvic ureteric portion. In spite of absent statistical difference in the success rate, ESWL should be chosen as the first treatment option in all cases of lumbar ureteric stones due to lower complication rate except for stones larger than 100mm2 that should be primarily treated endoscopically.

Keywords: ESWL, ureteroscopy, lithotripsy, ureteric stones, Complications