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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2016 Oct 21

language: English

Advantage of supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: outcomes based on computerized tomography characteristics

Riccardo GALLI, Maria C. SIGHINOLFI, Salvatore MICALI, Eugenio MARTORANA, Marco ROSA, Alessando MOFFERDIN, Giampaolo BIANCHI

Urology Department, University of Modena & Reggio Emilia, Modena, Italy


BACKGROUND: Shock Wave Lithotripsy (SWL) for distal ureteral stones can be performed in prone or supine position. Our aim is to demonstrate the advantage of the supine transgluteal SWL approach for distal ureteral stones treatment using a real times ultrasound (US) focusing and to show how the Computerized Tomography (CT) scan parameters may be related to the outcomes.
METHODS: We performed 70 consecutive supine transgluteal SWL of distal ureteral stones. All patients had a pre-treatment CT scan. We evaluated: stone size, Hounsfield Units density, skin to stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone free status. Stone focusing was obtained with ultrasonography (US), that allows a real time monitoring of stone location and fragmentation. Follow up included a kidney ureter bladder (KUB) film and ultrasound examination at 2-3 weeks after treatment (median time: 18 days). Stone free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone free status. P <.05 was considered as significant.
RESULTS: Median number of SWL sessions for patient was 1 (ICQ: 1-1), mean 1,2 +/- 0,5. The pretreatment rate for stone free patients was 18,3%. Stone free rate was 85.7%. A clear and real time US stone fragmentation was perceive by the surgeon during the treatment in 42/70 (60%) of patients and correlated to the definitive stone free status (p=0.04). Stone to ureteral osmium distance was the only variable affecting the stone free condition (p=0.01).
CONCLUSIONS: Supine transgluteal SWL of distal ureteral stones provide satisfactory outcomes in terms of stone free rate. The distance of the stone to the ureteral ostium, measured by CT, appeared to be the only significant variable connected to SWL success.

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