Articles

Collaborative Review – Stone Disease

Contemporary Management of Ureteral Stones

By: Markus J. Badera lowast , Brian Eisnerb, Francesco Porpigliac, Glen M. Premingerd and Hans-Goran Tiseliuse

European Urology, Volume 61 Issue 1, April 2012, Pages 764-772

Published online: 01 April 2012

Keywords: Ureteral calculi, Medical expulsive therapy (MET), Lithotripsy, Ureterorenoscopy, Extracorporal shockwave lithotripsy (SWL), Antegrade percutaneous litholapaxie (PCNL), Laparoscopic stone treatment

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Abstract

Context

Ureteral calculi represent a common condition that urologists encounter in everyday practice. Several treatment options are available for calculi that do not pass spontaneously or are unlikely to do so.

Objective

In this nonsystematic review, we summarize the existing data on contemporary management of ureteral stones focusing on medical expulsive therapy (MET) and different treatment modalities.

Evidence acquisition

A PubMed search was performed. We reviewed the recent literature on the management of ureteral calculi. Articles were considered between 1997 and 2011. Older studies were included selectively if historically relevant.

Evidence synthesis

For stones that do not pass spontaneously or with MET, shock wave lithotripsy (SWL) and ureteroscopy (URS) are the most common and efficient treatment modalities. Both techniques have obvious advantages and disadvantages as well as different patterns of complications. For select cases or patients, other modalities may be useful.

Conclusions

Ureteral stones of up to 10mm and eligible for observation may be offered MET. For most ureteral calculi that require treatment, advances in SWL and URS allow urologists to take a minimally invasive approach. Other more invasive treatments are reserved for select “nonstandard” cases.

Take Home Message

Removal of stones from the ureter is an important and extensive part of the care of patients with urinary tract stone disease. For smaller (<10-mm) ureteral stones in a reasonable asymptomatic patient, medical expulsive therapy is an excellent initial form of treatment. In terms of active stone removal, both shock wave lithotripsy and ureteroscopy have been shown to be useful alternatives.

Keywords: Ureteral calculi, Medical expulsive therapy (MET), Lithotripsy, Ureterorenoscopy, Extracorporal shockwave lithotripsy (SWL), Antegrade percutaneous litholapaxie (PCNL), Laparoscopic stone treatment.

Footnotes

a Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany

b Department of Urology, Kidney Stone Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

c C.D.U. Urologia Dipartimento di Scienze Cliniche e Biologiche, Facoltà di Medicina e Chirurgia San Luigi Gonzaga, Università degli Studi di Torino, Torino, Italy

d Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA

e Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

lowast Corresponding author. University of Munich, Urology, Marchioninistrasse 15, München 81377, Germany. Tel. +491717181325; Fax: +498970955444.

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