In situ Shock Wave Lithotripsy of Upper Ureteral Calculi: Affecting Factors of Retreatment

Shin, Han Chul; Kim, Jeong Min; Song, Ki Hak; Kim, Kwang Jin

Abstract

PURPOSE: In situ SWL has become the preferred treatment modality for proximal ureteral calculi. However, reported rate of retreatment and need for stone manipulation such as stenting or push back were considerably high. We tried to determine the clinical factors affecting retreatment rate for effective in situ SWL.
MATERIALS AND METHODS
One hundred seven patients with upper ureteral calculi underwent in situ SWL by using the Dornier MPL 9000 with ultrasound locating system. We evaluated the factors such as size and texture of the stone, degree of obstruction, distance from ureteropelvic junction and duration of symptom by comparing success rate of 1st session SWL.
RESULTS
The overall stone free rate was 93.9% at 3 months. Average number of session of SWL was 1.35. Sucess rate of 1st session was 71%(76/107). Retreatment rate after 1st session was 29%(31/107). The significant clinical factors affecting retreatment rate of SWL were size of stones( 1.2cm), texture(rough shape) and complete ureteral obstruction.
CONCLUSIONS
From these results we conclude that upper ureteral calculi with these factors should be performed primary in situ SWL more carefully to improved the therapeutic result.