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. 1993 Nov 27;307(6916):1414–1417. doi: 10.1136/bmj.307.6916.1414

Treatment of urinary tract stones.

J E Wickham 1
PMCID: PMC1679608  PMID: 8274898

Abstract

Replacement of open surgery with minimally invasive techniques for treating stones in the renal tract has greatly reduced patients' morbidity and mortality and the period of hospitalisation and convalescence. Extracorporeal shockwave lithotripsy does not require anaesthesia and requires little analgesia so that treatment can be given on an outpatient basis, and there is no wound to heal. Only a small puncture site is needed for percutaneous endoscopic lithotomy, and with the advent of prophylactic antibiotics there are few complications. Of renal stones, about 85% can now be successfully treated by extracorporeal lithotripsy alone, and almost all of the stones too large or hard for lithotripsy can be treated endoscopically, with ultrasonic or electrohydraulic probes being used to fragment the stone. Stones in the upper and lower thirds of the ureter can be treated by extracorporeal lithotripsy, but stones in the middle third, which cannot normally be visualised to allow focusing of the shockwaves, usually require ureteroscopy. Nearly all bladder stones can be treated by transurethral endoscopy with an electrohydraulic probe. Only the largest renal tract stones still require open surgery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alken P., Hutschenreiter G., Günther R. Percutaneous kidney stone removal. Eur Urol. 1982;8(5):304–311. doi: 10.1159/000473540. [DOI] [PubMed] [Google Scholar]
  2. Becht E., Moll V., Neisius D., Ziegler M. Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy. J Urol. 1988 May;139(5):916–918. doi: 10.1016/s0022-5347(17)42714-5. [DOI] [PubMed] [Google Scholar]
  3. Clayman R. V., Surya V., Hunter D., Castaneda-Zuniga W. R., Miller R. P., Coleman C., Amplatz K., Lange P. H. Renal vascular complications associated with the percutaneous removal of renal calculi. J Urol. 1984 Aug;132(2):228–230. doi: 10.1016/s0022-5347(17)49573-5. [DOI] [PubMed] [Google Scholar]
  4. Coptcoat M. J., Webb D. R., Kellett M. J., Whitfield H. N., Wickham J. E. The treatment of 100 consecutive patients with ureteral calculi in a British stone center. J Urol. 1987 Jun;137(6):1122–1123. doi: 10.1016/s0022-5347(17)44424-7. [DOI] [PubMed] [Google Scholar]
  5. Dretler S. P. An evaluation of ureteral laser lithotripsy: 225 consecutive patients. J Urol. 1990 Feb;143(2):267–272. doi: 10.1016/s0022-5347(17)39929-9. [DOI] [PubMed] [Google Scholar]
  6. Holmes S. A., Eardley I., Corry D. A., Nockler I., Whitfield H. N. The use of extracorporeal shock wave lithotripsy for medullary sponge kidneys. Br J Urol. 1992 Oct;70(4):352–354. doi: 10.1111/j.1464-410x.1992.tb15786.x. [DOI] [PubMed] [Google Scholar]
  7. Jones D. J., Wickham J. E., Kellett M. J. Percutaneous nephrolithotomy for calculi in horseshoe kidneys. J Urol. 1991 Mar;145(3):481–483. doi: 10.1016/s0022-5347(17)38374-x. [DOI] [PubMed] [Google Scholar]
  8. Lingeman J. E., Woods J. R., Toth P. D. Blood pressure changes following extracorporeal shock wave lithotripsy and other forms of treatment for nephrolithiasis. JAMA. 1990 Apr 4;263(13):1789–1794. [PubMed] [Google Scholar]
  9. Marberger M., Türk C., Steinkogler I. Painless piezoelectric extracorporeal lithotripsy. J Urol. 1988 Apr;139(4):695–699. doi: 10.1016/s0022-5347(17)42603-6. [DOI] [PubMed] [Google Scholar]
  10. Newman D. M., Coury T., Lingeman J. E., Mertz J. H., Mosbaugh P. G., Steele R. E., Knapp P. M. Extracorporeal shock wave lithotripsy experience in children. J Urol. 1986 Jul;136(1 Pt 2):238–240. doi: 10.1016/s0022-5347(17)44826-9. [DOI] [PubMed] [Google Scholar]
  11. Philp T., Kellett M. J., Whitfield H. N., Wickham J. E. Painless lithotripsy: experience with 100 patients. Lancet. 1988 Jan 2;1(8575-6):41–43. doi: 10.1016/s0140-6736(88)91014-8. [DOI] [PubMed] [Google Scholar]
  12. Psihramis K. E., Dretler S. P. Extracorporeal shock wave lithotripsy of caliceal diverticula calculi. J Urol. 1987 Oct;138(4):707–711. doi: 10.1016/s0022-5347(17)43349-0. [DOI] [PubMed] [Google Scholar]
  13. Rassweiler J., Gumpinger R., Miller K., Hölzermann F., Eisenberger F. Multimodal treatment (extracorporeal shock wave lithotripsy and endourology) of complicated renal stone disease. Eur Urol. 1986;12(5):294–304. doi: 10.1159/000472642. [DOI] [PubMed] [Google Scholar]
  14. Rassweiler J., Schmidt A., Gumpinger R., Mayer R., Eisenberger F. ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200. J Urol (Paris) 1990;96(3):149–153. [PubMed] [Google Scholar]
  15. Ruiz Marcellán F. J., Ibarz Servio L. Evaluation of renal damage in extracorporeal lithotripsy by shock waves. Eur Urol. 1986;12(2):73–75. doi: 10.1159/000472585. [DOI] [PubMed] [Google Scholar]
  16. Schulze H., Hertle L., Graff J., Funke P. J., Senge T. Combined treatment of branched calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. J Urol. 1986 Jun;135(6):1138–1141. doi: 10.1016/s0022-5347(17)46017-4. [DOI] [PubMed] [Google Scholar]
  17. Segura J. W., Patterson D. E., LeRoy A. J., May G. R., Smith L. H. Percutaneous lithotripsy. J Urol. 1983 Dec;130(6):1051–1054. doi: 10.1016/s0022-5347(17)51678-x. [DOI] [PubMed] [Google Scholar]
  18. Segura J. W., Patterson D. E., LeRoy A. J., Williams H. J., Jr, Barrett D. M., Benson R. C., Jr, May G. R., Bender C. E. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol. 1985 Dec;134(6):1077–1081. doi: 10.1016/s0022-5347(17)47633-6. [DOI] [PubMed] [Google Scholar]
  19. Stackl W., Marberger M. Late sequelae of the management of ureteral calculi with the ureterorenoscope. J Urol. 1986 Aug;136(2):386–389. doi: 10.1016/s0022-5347(17)44876-2. [DOI] [PubMed] [Google Scholar]
  20. Tiselius H. G., Pettersson B., Andersson A. Extracorporeal shock wave lithotripsy of stones in the mid ureter. J Urol. 1989 Feb;141(2):280–282. doi: 10.1016/s0022-5347(17)40740-3. [DOI] [PubMed] [Google Scholar]
  21. Vallancien G., Aviles J., Munoz R., Veillon B., Charton M., Brisset J. M. Piezoelectric extracorporeal lithotripsy by ultrashort waves with the EDAP LT 01 device. J Urol. 1988 Apr;139(4):689–694. doi: 10.1016/s0022-5347(17)42602-4. [DOI] [PubMed] [Google Scholar]
  22. Watson G. M., Wickham J. E. Initial experience with a pulsed dye laser for ureteric calculi. Lancet. 1986 Jun 14;1(8494):1357–1358. doi: 10.1016/s0140-6736(86)91667-3. [DOI] [PubMed] [Google Scholar]
  23. Wickham J. E., Kellett M. J., Miller R. A. Elective percutaneous nephrolithotomy in 50 patients: an analysis of the technique, results and complications. J Urol. 1983 May;129(5):904–906. doi: 10.1016/s0022-5347(17)52450-7. [DOI] [PubMed] [Google Scholar]
  24. Wickham J. E., Mathur V. K. Hypothermia in the conservative surgery of renal disease. Br J Urol. 1971 Dec;43(6):648–657. doi: 10.1111/j.1464-410x.1971.tb12082.x. [DOI] [PubMed] [Google Scholar]
  25. Williams C. M., Kaude J. V., Newman R. C., Peterson J. C., Thomas W. C. Extracorporeal shock-wave lithotripsy: long-term complications. AJR Am J Roentgenol. 1988 Feb;150(2):311–315. doi: 10.2214/ajr.150.2.311. [DOI] [PubMed] [Google Scholar]

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