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.
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.
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/)
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.
In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.
Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.
Double pigtail ureteric stent placement appears to be unnecessary in procedures considered ‘uncomplicated’ by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements.