Efficacy of Expulsive Medical Therapy Using Nifedipine or Tamsulosin After Shock Wave Lithotripsy of Ureteral Stones
S. Micali, A. Celia, S. Chiara, M. Grande, M. Bisi, S. De Stefani, G. Bianchi (J. Urol 173: Abst. 1680. May 25, 2005)
The use of pharmacologic manipulation to enhance ureteral stone passage is now well established. In this article, the authors applied these medicines prospectively to a group of 81 patients who had undergone shock wave lithotripsy (Dornier Lithotripter S) to see if a higher and more rapid stone free rate could be achieved. They used nifedipine at 30 mg/day for patients with upper/middle ureteral stones and tamsulosin 0.4 mg/day for patients with lower ureteral stones. Therapy was continued for a full two weeks. The stone free rate at 3 months, re-treatment rate, and time to stone free status all favored the medicated patients: 81% vs. 55%, 31% vs. 50%, and 50 days vs. 83 days.
A Prospective Randomized Clinical Trial Comparing Levels of Symptoms and Discomfort Associated with Two Investigational and Two Currently Marketed Ureteral Stents
G. Preminger, J. Lingeman, E. Goldfischer, et al. (J. Urol 173: Abst. 1683. May 25, 2005)
In this extensive study comprising 256 patients, a long loop tail stent and a short loop tail stent were compared to standard double pigtail stents. No statistically significant differences were noted with regard to body pain score or urinary symptom score. The search for a better, more comfortable ureteral stent continues.
Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy for Proximal Ureteral Calculi: A Prospective Randomized Study
R. Neururer, K. Tosun, R. Peschel, and G. Bartsch (J. Urol 173: Abst. 1690. May 25, 2005)
"It's the end of the world as we know it." In this study, the authors using a Philips Litho Diagnost M lithotripter were only able to achieve a 60% stone free rate among their patients with a proximal ureteral stone in the 4-16mm range; whereas the stone free rate after ureteroscopy was 90%. In addition, the treatment time was faster ureteroscopically than with shock wave lithotripsy (38 min. vs. 52 min.) The authors conclude: "For proximal ureteral stones we recommend ureteroscopy as first line treatment.". The failure of shock wave lithotripsy companies to provide urologists with second or third generation lithotripters of equivalent or superior efficacy to the original HM-3 (85-90% success for proximal ureteral stones with < 40 minutes of treatment time) has resulted in our slipping backward in time; the thought that we are becoming more, rather than less invasive surgeons, despite all of the advances in technology in other fields is both disheartening and disappointing. Will a return to open ureterolithotomy be the next new thing?
