MET should be offered as a treatment for patients with distal ureteral calculi who are amenable to awaiting management. Benefits associated with MET are a shorter time to stone expulsion and less need for analgesic drugs and hospitalization for treatment. MET is cost effective for the management of distal ureteral stones.
both AUA and EAU guidelines offer a detailed, evidence-based framework to guide the urologists in the management of stone diseases. Although some discrepancies exist, particularly regarding the choice of surgical management in specific scenarios, there is generally a consensus between both the groups. However, the guidelines are not applicable to every clinical situation and need to be used in conjunction with the most recently published material and tailored to each individual patient.
The frequency of stone disease in childhood ranges between 0.1-5 percent. Stone disease occurs as a result of enviromental, metabolic, anatomical, infectious and nutritional factors. Percutaneous nephrolitotomy, uretherorenoscopy, laparoscopic surgery, open surgery and extracorporeal shock wave lithothripsy are treatment alternatives for stone disease during childhood. However, these methods are not completely innocent. Some complications may occur after these procedures. These procedures are generally not cost- effective. Even invasive procedures have high success rates, so medical expulsive treatment modalities have become an alternative for a group of patients.
Alpha blockers may also be a useful adjunct in the treatment of both ureteral and renal stones with SWL. They may also reduce the urinary symptoms and pain associated with double-J ureteral stents. Further investigation is necessary to define the role of blockers in the treatment of proximal ureteral and renal stones, and to elucidate the potential mechanisms of renal stone clearance after surgical stone intervention.
The primary findings show a small overall benefit for a-blockers as MET for ureteric stones but no benefit with CCBs. a-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. a-blockers are associated with a greater risk of side-effects compared to placebo or CCBs. 2017 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
The AUA/EAU guidelines suggest MET as a reasonable treatment choice in select patients. Previous studies have demonstrated a significant benefit in stone expulsion rates with the use of MET. A review of the data suggests greater success rates occur with the use of alpha antagonist compared to calcium channel blockers. The use of MET is not limited to just those patients attempting passage of calculi without other interventions; there is also an advantage to MET in those subjects treated with other modalities (i.e. SWL and ureteroscopy). Even with multiple studies demonstrating the benefits of MET, it still is underutilized as a treatment modality. Education in the hospital setting appears to be beneficial in changing practice behaviors. MET may reduce medical costs and prevent unnecessary surgeries and the associated risks.
Only a minority of patients with ureteric calculi require surgical intervention. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET initially. The trial period may be extended up to 12-weeks depending on the control of symptoms and downward movement of the stone.
The SAV value is an independent predictor of the success of ESWL and a useful tool for planning stone treatment. Patients with a SAV P956 HU are not ideal candidates for ESWL. The inclusion criteria for ESWL of stones with a SAV <500HUcan be expanded with regard to stone size, site, age, renal function and coagulation profile. In patients with a SAV of 500–1000 HU, factors like a body mass index of >30 kg/m2 and a lower calyceal location make them less ideal for ESWL. ª 2014 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.
This study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL.
ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning. 2016 Arab Association of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/)
Time to lithotripsy is strongly associated with SFR followingSWL. SWL in an urgent care setting does not improveSFR if it is performed within 1 month, while time toSWL > 2 months reduces the likelihood of stone-free status.
The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.