Transurethral uretero-lithotripsy of ureteral stones in osaka city university

Abstract

During the 39 months since the introduction of transurethral lithotripsy (TUL) for the treatment of ureteral stones at our hospital in August 1985, TUL was performed a total of 200 times in 178 patients with ureteral stones. Among them, 111 patients had left ureteral stones and 65 had right ureteral stones, while 2 patients had ureteral stones in both sides. The stones were divided into upper ureteral stone (84 patients) and lower ureteral stone (94 patients) at above and below the iliac brim. 89% of the stones were less than 2 cm in diameter. Most of the patients were given lumbar anesthesia, and a guide wire was inserted into the ureter. The ureter was dilated with a ureteral bougie, and a 13F or 14F Storz ureteroscope was inserted. The stones were disintegrated by an ultrasound lithotripto and removed using forceps and a basket catheter. After the TUL procedure, a double J catheter was indwelled and removed within 5 days. The results were evaluated by DIP which was done 2 to 3 months after TUL. The success rate included residual stones less than 4 mm in diameter, as they could be spontaneously discharged. As a result, the success rate for upper ureteral stones was 53%, and it was higher for smaller stones. On the other hand, the success rate for lower ureteral stones was 85% and significantly higher. The main reasons for failure were the upper migration of the stones (60%) and inability to insert the ureteroscope up to the stone due to ureterostenosis and ureteral perforation (39%). As for complications, ureteral perforation (13 cases), complete ureteral upture (one case), bladder perforation (one case) and subcapsular hematoma (one case) were observed. In the early stage, fever of over 38°C was seen in 16% of the patients, and in the latter stage, grade 1 VUR and ureterostenosis were seen in 3 patients each. These results suggest that although ESWL is more effective for upper ureteral stones, TUL is recommended for lower ureteral stones. © 1989, THE JAPANESE UROLOGICAL ASSOCIATION. All rights reserved.