Ureteral stone manipulation before extracorporeal shock wave lithotripsy

Area of Science:

• Urology
• Nephrology
• Endourology

Background:

• Ureteral calculi management often requires stone manipulation.
• Effective adjunctive procedures can improve treatment outcomes.
• Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for stones.

Purpose of the Study:

• To evaluate the efficacy of different intraureteral instillations prior to repeat stone manipulation.
• To assess the success rates of retrograde manipulation for ureteral stones.
• To determine the role of retrograde manipulation as an adjunct to ESWL.

Main Methods:

• Randomized controlled trial involving 75 patients with solitary ureteral calculi.
• Comparison of saline, 2% lidocaine viscous solution, and dilute surgical lubricant instillations.
• Assessment of stone return to the pelvis and ESWL outcomes.

Main Results:

• No statistically significant difference in stone manipulation success rates among the three instilled solutions.
• Success rates varied by stone location (upper 80%, mid 54%, lower 30%) and size (≤0.5 cm: 77%, 0.6-1.0 cm: 72%, >1.0 cm: 38%).
• Retrograde manipulation was effective before ESWL, reducing the need for repeat ESWL and interventions like percutaneous nephrostomy.

Conclusions:

• Intraureteral instillations of saline, lidocaine, or lubricant do not significantly enhance success rates of repeat ureteral stone manipulation.
• Retrograde manipulation is a valuable adjunct to ESWL for ureteral stones, improving treatment efficiency.
• Stone characteristics (location, size) significantly influence manipulation success rates.