[Extracorporeal piezoelectric lithotripsy in the treatment of calculi of the ureter. Apropos of a series of 143 cases]

Abstract

The results obtained in 143 cases or ureteral stones treated by EDAP LT-01 were analysed concerning stone location, ureteral manipulation, and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter higher than the lower pole of the kidney (PU1), proximal ureter between the lower pole and the iliac crest (PU2), mid-ureter between the iliac crest and the lower end of the sacroiliac joint (MU), distal ureter between the lower end of the sacroiliac joint and the ischial spine (DU1), and the distal ureter below the ischial spine to the meatus (DU2). The overall fragmentation rate (FR) was 72%, as detailed below: (table; see text) Anesthesia or iv sedation was never used for EPL. 28% of the patients underwent retrograde ureteral manipulation (29/103). For PU1, the FR was twice as high after retrograde manipulation (push back/in situ = 5/8). For UPJ, the supine position was most common. For PU1 and PU2, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder had to be well filled and the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month follow-up) is 93% (27/29). The stone-free rate for in situ stones at 3 months is 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones.(ABSTRACT TRUNCATED AT 250 WORDS)