Ureteral Stones Clinical Trial
Official title:
Comparative Study of Extracorporeal Shock Wave Lithotripsy and Ureteroscopy in Management of Upper Third Ureteral Calculi
comparative study of two treatment modalities (ureteroscopy and extracorporeal shock wave lithotripsy) in management of upper third ureteral calculi
Large impacted upper ureteral calculus is defined as a stone located above the lower border
of the fourth lumbar vertebra, remaining fixed at the same site for at least six weeks.
Moreover, it is associated with hydronephrosis and/or prevents contrast medium from passing
below the calculus on intravenous urography (IVU).Moreover, there is inability to pass a
guidewire or catheter beyond the stone at initial attempts. The treatment for patients with
large impacted proximal ureteral stone remains controversial; the surgical options for the
treatment of proximal ureteral stones include extracorporeal shockwave lithotripsy (ESWL),
Ureteroscopy, PCNL and rarely Laparoscopic or Open surgery. Every technique has its own
limitations. The aim of this study is to compare and to evaluate the outcome and
complications of two main treatments procedures for impacted proximal ureteral calculi,
Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy.
Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy are two common modalities in
the management of Proximal Ureteral Calculi.European Association of Urology (EAU) and
American Urological Association (AUA) guidelines have recommended URS or ESWL as first-line
treatment Options.ESWL is an effective and non-invasive treatment method in urolithiasis,
particularly in stones located in the upper third of the ureters.However, URS is a more
invasive technique when compared to ESWL, URS became the most efficient treatment method in
proximal ureteral calculi after the development of small-caliber, semi-rigid and flexible
endoscopes and the holmium:YAG laser. Today, the greatest dilemma faced by Urologists is to
choose between ESWL and URS. A number of factors influence the final results of ESWLand if no
fragmentation occurs after several unsuccessful sessions, the stone is considered
ESWL-resistant; the case is deemed an ESWL-failure and the patient therefore undergoes
URS.URS has been described as a salvage or second line treatment option in cases of
ESWL-resistant calculi
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