The Factors on Success in Push-up of Ureteral Stone: A Review of 103 Cases

Park, Cheon Jin; Kim, Kwan Jin

Abstract

The ancillary practice for the management of upper ureteral stones is to push the stone up the renal pelvis before extracorporeal shock wave lithotripsy(ESWL). We evaluated 103 patients with mid and upper ureteral stones for identifying the significant factors of success in push up procedure. The clinical factors of success of push up procedure may be regarded to location (upper, mid), size( 12mm>=,12mm<), duration of impaction( 1Mo>=, 1Mo<), duration of symptoms (1Mo>=, 1Mo<), smoothness of the surface of the stone (Smooth, Rough), degree of obstruction (partial, complete), pyuria or not (WBC> 5, WBC<=5 in microscopic urinalysis) Our results showed that the success rate of push up were 92.7%, 96.3%, 92.9%, 93.3%, 96.6 %, 94.4%, and 93.5% in the case of upper ureter stone, less than 12mm in diameter in stone size, less than 1 month in duration of initial symptoms and impaction, smooth stone surface, partial obstruction, presence of pyuria, respectively compared to 28.6%, 60.7%, 68.4%, 53.3%, 77.8 %, 75%. and 84.2% in the case of mid ureter stone. more than 12mm in diameter, more than 1 month in duration of initial symptoms and impaction, rough stone surface, complete obstruction, absence of pyuria respectively. These are clinically significant factors of affecting success in push up procedure (P<0.05 ) except appearance of pyuria or not (P>0.05). Complications of push up were infrequent, with hematuria (30.7%), flank pain (29.7% ), and ureteral perforation (2.2% ), all of which were managed conservatively. From these data we conclude that upper ureter stones with successful clinical factors should be tried push-up into the renal pelvis before ESWL to improve the therapeutic results.