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Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy.
J Urol. 2002 May; 167(5):1972-6.JU

Abstract

PURPOSE

We compared the safety and efficacy of ureteroscopy with intracorporeal holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) for proximal ureteral calculi.

MATERIALS AND METHODS

A total of 67 patients underwent 81 primary procedures, including in situ ESWL with a DoLi 50 lithotriptor (Dornier Medical Systems, Inc.) or ureteroscopy combined with holmium:YAG laser lithotripsy for proximal ureteral calculi.

RESULTS

Of the primary procedures 81 involved proximal ureteral calculi, including 35 done for calculi 1 cm. or greater. The initial stone-free rate in patients with calculi 1 cm. or greater was 93% for ureteroscopy combined with holmium:YAG laser lithotripsy and 50% for in situ ESWL. The efficiency quotient for treating proximal ureteral calculi 1 cm. or greater was calculated as 0.76 for ureteroscopic lithotripsy and 0.43 for ESWL. For proximal ureteral calculi less than 1 cm. the initial stone-free rate was 100% and 80% for ureteroscopic laser lithotripsy and ESWL, respectively. The efficiency quotient was calculated as 0.81 for ureteroscopic lithotripsy and 0.72 for ESWL for treating proximal ureteral calculi less than 1 cm. There were no major complications in either group and all procedures were performed on an outpatient basis.

CONCLUSIONS

Our study demonstrates that ureteroscopy combined with holmium:YAG laser lithotripsy is an acceptable treatment modality for all proximal ureteral calculi and excellent results are achieved for calculi 1 cm. or larger. Although the stone-free rate was better for smaller stones with ureteroscopic laser lithotripsy, efficiency quotients were similar. Therefore, ESWL should remain first line therapy for proximal ureteral calculi less than 1 cm. because of less morbidity, and a lesser anesthesia and analgesic requirement.

Authors+Show Affiliations

Department of Urology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11956420

Citation

Lam, John S., et al. "Treatment of Proximal Ureteral Calculi: holmium:YAG Laser Ureterolithotripsy Versus Extracorporeal Shock Wave Lithotripsy." The Journal of Urology, vol. 167, no. 5, 2002, pp. 1972-6.
Lam JS, Greene TD, Gupta M. Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol. 2002;167(5):1972-6.
Lam, J. S., Greene, T. D., & Gupta, M. (2002). Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. The Journal of Urology, 167(5), 1972-6.
Lam JS, Greene TD, Gupta M. Treatment of Proximal Ureteral Calculi: holmium:YAG Laser Ureterolithotripsy Versus Extracorporeal Shock Wave Lithotripsy. J Urol. 2002;167(5):1972-6. PubMed PMID: 11956420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. AU - Lam,John S, AU - Greene,Tricia D, AU - Gupta,Mantu, PY - 2002/4/17/pubmed PY - 2002/5/1/medline PY - 2002/4/17/entrez SP - 1972 EP - 6 JF - The Journal of urology JO - J. Urol. VL - 167 IS - 5 N2 - PURPOSE: We compared the safety and efficacy of ureteroscopy with intracorporeal holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) for proximal ureteral calculi. MATERIALS AND METHODS: A total of 67 patients underwent 81 primary procedures, including in situ ESWL with a DoLi 50 lithotriptor (Dornier Medical Systems, Inc.) or ureteroscopy combined with holmium:YAG laser lithotripsy for proximal ureteral calculi. RESULTS: Of the primary procedures 81 involved proximal ureteral calculi, including 35 done for calculi 1 cm. or greater. The initial stone-free rate in patients with calculi 1 cm. or greater was 93% for ureteroscopy combined with holmium:YAG laser lithotripsy and 50% for in situ ESWL. The efficiency quotient for treating proximal ureteral calculi 1 cm. or greater was calculated as 0.76 for ureteroscopic lithotripsy and 0.43 for ESWL. For proximal ureteral calculi less than 1 cm. the initial stone-free rate was 100% and 80% for ureteroscopic laser lithotripsy and ESWL, respectively. The efficiency quotient was calculated as 0.81 for ureteroscopic lithotripsy and 0.72 for ESWL for treating proximal ureteral calculi less than 1 cm. There were no major complications in either group and all procedures were performed on an outpatient basis. CONCLUSIONS: Our study demonstrates that ureteroscopy combined with holmium:YAG laser lithotripsy is an acceptable treatment modality for all proximal ureteral calculi and excellent results are achieved for calculi 1 cm. or larger. Although the stone-free rate was better for smaller stones with ureteroscopic laser lithotripsy, efficiency quotients were similar. Therefore, ESWL should remain first line therapy for proximal ureteral calculi less than 1 cm. because of less morbidity, and a lesser anesthesia and analgesic requirement. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/11956420/Treatment_of_proximal_ureteral_calculi:_holmium:YAG_laser_ureterolithotripsy_versus_extracorporeal_shock_wave_lithotripsy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)65065-3 DB - PRIME DP - Unbound Medicine ER -