Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach?
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UROLOGY - ORIGINAL PAPER
Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach? M. Gaber Soliman1 · T. Gameel1 · H. El‑Tatawy1 · A. Shawky El‑Abd1 Received: 4 May 2020 / Accepted: 9 July 2020 © Springer Nature B.V. 2020
Abstract Objective To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one. Patients and methods This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments ( 18 years with a single radiopaque stone in the lower third ureter with a maximum diameter of 15 mm based on NCCT (noncontrast spiral computed tomography) were included in our study after obtaining their consent. Patients with bilateral ureteric stones, solitary kidney, distal ureteric stricture, severe hydroureteronephrosis, ureteric stent or ipsilateral nephrostomy, renal insufficiency, uncontrollable coagulopathy, pregnancy or females in the child-bearing period were excluded from the study. All eligible patients for the study were assessed with history, routine examination, body mass index (BMI), urine analysis, serum creatinine, prothrombin time and activity (INR), plain X-ray, pelvi-abdominal US, and NCCT. Stone characteristics included the location, stone size as indicated by the maximum stone diameter, skin to stone distance (SSD), mean stone density on CT scan. Mean stone density was measured in Hounsfield units (HUs). Patients were randomized into three groups using a predefined randomization sequence created by a computer random number generator. Group A: supine transgluteal in which the patient is positioned supine with the head therapy against the patient’s buttock at an angle of 40° to the vertical axis, group B: modified prone in which the stone side is positioned on the head therapy and the treatment table is rotated externally [12] and group C: prone position in which the head therapy was placed on the patient’s anterior abdomen. The patients were given an i.v. analgesia for pain control and fluids; glucose 25% diuretic dose in non-diabetic patients and normal saline in people with diabetes during and 2 h after the procedure. Before the start of the session, the patients were prepared with local xylocaine gel 2% at the site of head therapy (the site of shockwave entrance). ESWL was performed, using Dornier Compact Delta 2 while
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International Urology and Nephrology
the patient was in different positions according to his/her group with the stone side towards the head therapy. All procedures were conducted under fluoroscopic guidance and the stone adjustment was done using the C ARM in the A/P and 30-degree position. All
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