Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled...Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled trials that were used to treat distal ureteral stone. Methods: Eligible studies were identified from electronic databases. Database search, quality assessment, and data extraction were performed by two reviewers independently. Our primary outcome was the stone-free rate. Secondary outcomes were the fragmentation rate, complications and the rate of re-treatment and secondary procedures. The results were assessed by Review Manager 5.0. Publication bias was evaluated by Stata 11.0. Results: 13 trials were included. Meta-analysis of pooled data showed that pneumatic ureteroscopic lithotripsy demonstrated a significant advantage over extracorporeal shock wave lithotripsy (OR = 0.14, 95% CI [0.09, 0.23], P < 0.00001) in the stone-free rate;the extracorporeal shock wave lithotripsy had statistical disadvantages over pneumatic ureteroscopic lithotripsy in the fragmentation rate of ureteral stones (OR = 0.14, 95% CI [0.05, 0.39], P = 0.0002);and the rate of re-treatment and secondary procedure was lower in pneumatic ureteroscopic lithotripsy than in extracorporeal shock wave lithotripsy (OR = 5.37, 95% CI [2.61, 11.07], P < 0.00001). Our pooled results showed that there was no statistical difference between extracorporeal shock wave lithotripsy and pneumatic ureteroscopic lithotripsy in hematuresis, ureteral stricture and urosepsis or fever. Finally extracorporeal shock wave lithotripsy had a higher incidence of colic pain than pneumatic ureteroscopic lithotripsy. Conclusion: The present meta-analysis suggested that pneumatic ureteroscopic lithotripsy had large advantages over extracorporeal shock wave lithotripsy in the treatment of lower ureteral stones.展开更多
Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and C...Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.展开更多
Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not ...Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.展开更多
Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney...Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney or ureter accepted ESWL. The kidney stones were sorted by FDA standard. The ureteric stone was sorted by its site and retrograde pyelography. At the same time, we summarized the recurrence of kidney stone and its relationship between extracorporeal shock wave lithotripsy （ ESWL ） and hypertension. Results The efficacy for class I kidney stone was 91.2% that for class II 86. 5% and class III 72.3% , the healing rate for ureteric stone was 84. 5%. Combined retrograde pyelography and ESWL couM improve the efficacy. If ESWL failed, the ureteric stone could still be removed by operation or ureterscopy （ 1.1% ）. The rate of recurrence of kidney stone was 6. 1% and the incidence of hypertension post-treatment reached 7. 9%. Conclusion ESWL is a preferred approach to treat urinary calculi.展开更多
Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary li...Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy （ESWL）. Two patients had stones sized ＜0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone （1.2 cm）, which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.展开更多
文摘Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled trials that were used to treat distal ureteral stone. Methods: Eligible studies were identified from electronic databases. Database search, quality assessment, and data extraction were performed by two reviewers independently. Our primary outcome was the stone-free rate. Secondary outcomes were the fragmentation rate, complications and the rate of re-treatment and secondary procedures. The results were assessed by Review Manager 5.0. Publication bias was evaluated by Stata 11.0. Results: 13 trials were included. Meta-analysis of pooled data showed that pneumatic ureteroscopic lithotripsy demonstrated a significant advantage over extracorporeal shock wave lithotripsy (OR = 0.14, 95% CI [0.09, 0.23], P < 0.00001) in the stone-free rate;the extracorporeal shock wave lithotripsy had statistical disadvantages over pneumatic ureteroscopic lithotripsy in the fragmentation rate of ureteral stones (OR = 0.14, 95% CI [0.05, 0.39], P = 0.0002);and the rate of re-treatment and secondary procedure was lower in pneumatic ureteroscopic lithotripsy than in extracorporeal shock wave lithotripsy (OR = 5.37, 95% CI [2.61, 11.07], P < 0.00001). Our pooled results showed that there was no statistical difference between extracorporeal shock wave lithotripsy and pneumatic ureteroscopic lithotripsy in hematuresis, ureteral stricture and urosepsis or fever. Finally extracorporeal shock wave lithotripsy had a higher incidence of colic pain than pneumatic ureteroscopic lithotripsy. Conclusion: The present meta-analysis suggested that pneumatic ureteroscopic lithotripsy had large advantages over extracorporeal shock wave lithotripsy in the treatment of lower ureteral stones.
文摘Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.
文摘Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.
文摘Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney or ureter accepted ESWL. The kidney stones were sorted by FDA standard. The ureteric stone was sorted by its site and retrograde pyelography. At the same time, we summarized the recurrence of kidney stone and its relationship between extracorporeal shock wave lithotripsy （ ESWL ） and hypertension. Results The efficacy for class I kidney stone was 91.2% that for class II 86. 5% and class III 72.3% , the healing rate for ureteric stone was 84. 5%. Combined retrograde pyelography and ESWL couM improve the efficacy. If ESWL failed, the ureteric stone could still be removed by operation or ureterscopy （ 1.1% ）. The rate of recurrence of kidney stone was 6. 1% and the incidence of hypertension post-treatment reached 7. 9%. Conclusion ESWL is a preferred approach to treat urinary calculi.
文摘Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy （ESWL）. Two patients had stones sized ＜0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone （1.2 cm）, which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.
