Skip to main content
SpringerLink
Log in

Immediate or delayed SWL in ureteric stones: a prospective and randomized study

  • Original Paper
  • Published:
Urological Research Aims and scope Submit manuscript

Abstract

The objective is to compare immediate and delayed SWL as a treatment for ureter stones between 5 and 20 mm. Patients who applied to the emergency department with single, radio opaque ureteric stone of 5–20 mm size were included in the study. Patients were randomized into immediate and delayed SWL groups. SWL were carried out after pain relief in the delayed group. Maximum of three SWL sessions were applied to the patients with stones of 5 mm or bigger in diameter, leaving at least 3 days interval in-between. Stone-free rate after first session was similar in two groups. When CIRF was also considered as success, the success rate of SWL in the immediate SWL group was higher after first session (p = 0.02). Immediate SWL had a greater success rate in upper ureteric stones (p = 0.019). Overall average time required for elimination of stones was shorter in immediate SWL group than delayed SWL group (p = 0.033). The success rate after first SWL session (including CIRF) was 59 % for patients with chronic pain in the delayed group and 100 % for patients with acute pain in the immediate group. According to the hydronephrosis grade, success rates were 71 and 44.4 % for patients with grade 1 or no hydronephrosis in the immediate SWL group, and for patients with grade 2 or larger hydronephrosis in the delayed SWL group, respectively, after first SWL session. Immediate SWL insures stone-free status in a shorter time in cases with renal colicky pain and ureteral stones, particularly upper ureteral stones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

SWL:

Extracorporeal shock wave lithotripsy

EAU:

European Association of Urology

AUA:

American Urological Association

PAR:

Plain abdominal radiographs

URS:

Ureteroscopic lithotripsy

PNL:

Percutaneous nephrolithotomy

USG:

Ultrasonography

NCCT:

Noncontrast computed tomography

ER:

Emergency department

VPS:

Visual pain scale

CIRF:

Clinically insignificant residual fragment

References

  1. Ghalayini I, Al-Ghazo M, Khader Y (2008) Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones. Int Braz J Urol 34:433–442

    PubMed  Google Scholar 

  2. Segura JW, Preminger GM, Assimos DG et al (1997) Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 158:1915–1921

    Article  PubMed  CAS  Google Scholar 

  3. Tombolini P, Ruoppolo M, Bellorofonte C et al (2000) Lithotripsy in the treatment of urinary lithiasis. J Nephrol 13(Suppl 3):S71–S82

    PubMed  Google Scholar 

  4. Preminger GM, Tiselius HG, Assimos DG (2007) Guideline for the management of ureteral calculi. Eur Urol 52:1610–1631

    Article  PubMed  Google Scholar 

  5. Azm TA, Higazy H (2002) Effect of diuresis on extracorporeal shockwave lithotripsy treatment of ureteric stones. Scand J Urol Nephrol 36:209–212

    Article  PubMed  CAS  Google Scholar 

  6. Mueller SC, Wilbert D, Thueroff JW et al (1986) Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience and experimental findings. J Urol 135:831–834

    PubMed  CAS  Google Scholar 

  7. Parr NJ, Pye SD, Ritchie AWS et al (1992) Mechanisms responsible for diminished fragmentation of ureteral calculi: an experimental and clinical study. J Urol 148:1079–1083

    PubMed  CAS  Google Scholar 

  8. Doublet JD, Tchala K, Tligui M et al (1997) In situ extracorporeal shock wave lithotripsy for acute renal colic due to obstructing ureteral stones. Scand J Urol Nephrol 31:137–139

    Article  PubMed  CAS  Google Scholar 

  9. Joshi HB, Obadeyi OO, Rao PN (1999) A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones. BJU Int 84:264–269

    Article  PubMed  CAS  Google Scholar 

  10. Kravchick S, Bunkin I, Stepnov E et al (2005) Emergency extracorporeal shockwave lithotripsy for acute renal colic caused by upper urinary-tract stones. J Endourol 19:1–4

    Article  PubMed  Google Scholar 

  11. Tombal B, Mawlawi H, Feyaerts A et al (2005) Prospective randomized evaluation of emergency extracorporeal shock wave lithotripsy (ESWL) on the short-time outcome of symptomatic ureteral stones. Eur Urol 47:855–859

    Article  PubMed  Google Scholar 

  12. Seitz CFH, Remzi M, Waldert M et al (2006) Rapid extracorporeal shock wave lithotripsy treatment after a first colic episode correlates with accelerated ureteral stone clearance. Eur Urol 49:1099–1105

    Article  PubMed  Google Scholar 

  13. Seitz C, Tanovic E, Kikic Z et al (2007) Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients. Eur Urol 52:1223–1227

    Article  PubMed  Google Scholar 

  14. Kumar A, Mohanty NK, Jain M et al (2010) A prospective randomized comparison between early (<48 h onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol 24(12):2059–2066

    Article  PubMed  Google Scholar 

  15. Kriegshauser JS, Carroll BA (1991) The urinary tract. In: Rumack CM, Wilson SR, Charboneau JW (eds) Diagnostic ultrasound, Mosby Year Book, St.Louis, p 242

  16. Robert M, Delbos O, Guiter J et al (1995) In situ piezoelectric extracorporeal shock wave lithotripsy of ureteric stones. Br J Urol 76:435–439

    Article  PubMed  CAS  Google Scholar 

  17. Farsi HM, Mosli HA, Alzimaity M (1994) In situ extracorporeal shock wave lithotripsy for primary ureteric calculi. Urology 43:776–781

    Article  PubMed  CAS  Google Scholar 

  18. Seitz C, Fajkovic H, Waldert M et al (2005) Extracorporeal shock wave lithotripsy in the treatment of proximal ureteral stones: does the presence and degree of hydronephrosis affect success? Eur Urol 49:378–383

    Article  PubMed  Google Scholar 

  19. Demirbas M, Kose AC, Samli M et al (2004) Extracorporeal shock wave lithotripsy for solitary distal ureteral stones: does the degree of ureteral obstruction affect success? J Endourol 18:237–240

    Article  PubMed  Google Scholar 

  20. Zagoria RJ, Khatod EG, Chen MYM (2001) Abdominal radiography after CT reveals urinary calculi: a method to predict usefulness of abdominal radiography on the basis of size and CT attenuation of calculi. AJR 176:1117–1122

    PubMed  CAS  Google Scholar 

  21. Tligui M, El Khadime MR, Tchala K et al (2003) Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones. Eur Urol 43:552–555

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urology Department, GATA Haydarpasa Teaching Hospital, Uskudar, Istanbul, 34668, Turkey

    Sami Uguz, Temucin Senkul, Hasan Soydan, Ferhat Ates, Ilker Akyol & Kadir Vehbi Baykal

  2. Corlu Military Hospital, Tekirdag, Turkey

    Ercan Malkoc

Authors
  1. Sami Uguz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Temucin Senkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hasan Soydan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ferhat Ates
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilker Akyol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ercan Malkoc
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kadir Vehbi Baykal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hasan Soydan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uguz, S., Senkul, T., Soydan, H. et al. Immediate or delayed SWL in ureteric stones: a prospective and randomized study. Urol Res 40, 739–744 (2012). https://doi.org/10.1007/s00240-012-0490-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-012-0490-2

Keywords

Search

Navigation