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Management of the impacted ureteral calculus
A Morgentaler1, S S Bridge, S P Dretler
1Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston.
The Journal of Urology
|February 1, 1990
Summary
Managing impacted ureteral calculi (ureteral stones) can be effectively treated with minimally invasive techniques. Laser fragmentation and extracorporeal shock wave lithotripsy achieve high success rates, avoiding open surgery.
Area of Science:
- Urology
- Nephrology
- Endourology
Background:
- Impacted ureteral calculi present a challenge in stone management.
- Defining impacted stones as those impassable by guide wire or catheter is crucial.
Purpose of the Study:
- To review the management of impacted ureteral calculi.
- To evaluate the efficacy of various treatment modalities for impacted stones at different ureteral levels.
Main Methods:
- Retrospective review of 42 patients with impacted ureteral calculi.
- Treatment strategies included laser fragmentation, extracorporeal shock wave lithotripsy (ESWL), and ultrasound.
- Disimpaction maneuvers were employed prior to definitive treatment for certain stone locations.
Main Results:
- Successful treatment without open surgery in 95% (40/42) of patients.
- Upper ureteral stones: 8 treated with ESWL post-disimpaction.
- Mid ureteral stones: 7 treated with laser, 4 with ESWL post-disimpaction.
- Lower ureteral stones: 17 treated with laser, 2 with ultrasound.
- Complications included perforations and false passages.
Conclusions:
- Minimally invasive techniques, including laser and ESWL, are highly effective for impacted ureteral calculi.
- A tailored approach based on stone location and characteristics optimizes treatment outcomes.
- Current strategy involves ureteroscopy for disimpaction, followed by ESWL for proximal/large stones or laser/ultrasound for distal stones.