Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Urolithiasis
Published in: Urolithiasis 6/2017

01-12-2017 | Original Paper

Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies

Authors: Davide Arcaniolo, Marco De Sio, Jens Rassweiler, Jilian Nicholas, Estevão Lima, Giuseppe Carrieri, Evangelos Liatsikos, Vincenzo Mirone, Manoj Monga, Riccardo Autorino

Published in: Urolithiasis | Issue 6/2017

Login to get access

Abstract

Objective

To analyze the current evidence on the use of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for the management of obstructing ureteral stones in emergent setting.

Methods

A systematic literature review was performed up to June 2016 using Pubmed and Ovid databases to identify pertinent studies. The PRISMA criteria were followed for article selection. Separate searches were done using a combinations of several search terms: “laser lithotripsy”, “ureteroscopy”, “extracorporeal shock wave lithotripsy”, “ESWL”, “rapid”, “immediate”, “early”, “delayed”, “late”, “ureteral stones”, “kidney stones”, “renal stones”. Only titles related to emergent/rapid/immediate/early (as viably defined in each study) versus delayed/late treatment of ureteral stones with either URS and/or ESWL were considered for screening. Demographics and operative outcomes were compared between emergent and delayed lithotripsy. RevMan review manager software was used to perform data analysis.

Results

Four studies comparing emergent (n = 526) versus delayed (n = 987) URS and six studies comparing emergent (n = 356) versus delayed (n = 355) SWL were included in the analysis. Emergent URS did not show any significant difference in terms of stone-free rate (91.2 versus 90.9%; OR 1.04; CI 0.71, 1.52; p = 0.84), complication rate (8.7% for emergent versus 11.5% for delayed; OR 0.94; CI 0.65, 1.36; p = 0.74) and need for auxiliary procedures (OR 0.85; CI 0.42, 1.7; p = 0.85) when compared to delayed URS. Emergent ESWL was associated with a higher likelihood of stone free status (OR 2.2; CI 1.55, 3.17; p < 0.001) and a lower likelihood of need for auxiliary maneuvers (OR 0.49; CI 0.33, 0.72; p < 0.001) than the delayed procedure. No differences in complication rates were noticed between the emergent and delayed ESWL (p = 0.37).

Conclusions

Emergent lithotripsy, either ureteroscopic or extracorporeal, can be offered as an effective and safe treatment for patients with symptomatic ureteral stone. If amenable to ESWL, based on stone and patient characteristics, an emergent approach should be strongly considered. Ureteroscopy in the emergent setting is mostly reserved for distally located stones. The implementation of these therapeutic approaches is likely to be dictated by their availability.
Literature
1.
Teichman JM (2004) Clinical practice acute renal colic from ureteral calculus. N Engl J Med 350:684–693CrossRefPubMed
2.
Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69(3):468–474CrossRefPubMed
3.
Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482CrossRefPubMed
4.
Wright PJ, English PJ, Hungin AP, Marsden SN (2002) Managing acute renal colic across the primary-secondary care interface: a pathway of care based on evidence and consensus. BMJ 325:1408–1412CrossRefPubMedPubMedCentral
5.
Cui X, Ji F, Yan H et al (2015) Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology 85(4):748–756CrossRefPubMed
6.
Lucarelli G, Ditonno P, Bettocchi C et al (2013) Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury. J Urol 189(3):960–965CrossRefPubMed
7.
Joshi HB, Obadeyi OO, Rao PN (1999) A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones. BJU Int 84(3):264–269CrossRefPubMed
8.
Picozzi SC, Ricci C, Gaeta M et al (2012) Urgent shock wave lithotripsy as first-line treatment for ureteral stones: a meta-analysis of 570 patients. Urol Res 40(6):725–731CrossRefPubMed
9.
Torricelli FC, Marchini GS, Pedro RN, Monga M (2016) Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices. Minerva Urol Nefrol 68(6):516–526PubMed
10.
Osorio L, Lima E, Soares J et al (2007) Emergency ureteroscopic management of ureteral stones: why not? Urology 69(1):27–31CrossRefPubMed
11.
Picozzi SC, Ricci C, Gaeta M et al (2012) Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients. Urol Res 40(5):581–586CrossRefPubMed
12.
Blackwell RH, Barton GJ, Kothari AN et al (2016) Early intervention during acute stone admissions: revealing “the weekend effect” in urological practice. J Urol 196(1):124–130CrossRefPubMedPubMedCentral
13.
14.
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMed
15.
16.
Youn JH, Kim SS, Yu JH, Sung LH, Noh CH, Chung JY (2012) Efficacy and safety of emergency ureteroscopic management of ureteral calculi. Korean J Urol 53(9):632–635CrossRefPubMedPubMedCentral
17.
Guercio S, Ambu A, Mangione F et al (2011) Randomized prospective trial comparing immediate versus delayed ureteroscopy for patients with ureteral calculi and normal renal function who present to the emergency department. J Endourol 25:1137–1141CrossRefPubMed
18.
Sarica K, Tanriverdi O, Aydin M et al (2011) Emergency ureteroscopic removal of ureteral calculi after first colic attack: is there any advantage? Urology 78:516–552CrossRefPubMed
19.
Matani YS, Al-Ghazo MA, Al-Azab RS, Hani OB, Ghalayini IF, Hani IB (2013) Emergency versus elective ureteroscopic treatment of ureteral stones. Can Urol Assoc J 7(7–8):E470–E474CrossRefPubMedPubMedCentral
20.
Kravchick S, Bunkin I, Stepnov E, Peled R, Agulansky L, Cytron S (2005) Emergency extracorporeal shockwave lithotripsy for acute renal colic caused by upper urinary-tract stones. J Endourol 19(1):1–4CrossRefPubMed
21.
Tombal B, Mawlawi H, Feyaerts A, Wese FX, Opsomer R, Van Cangh PJ (2005) Prospective randomized evaluation of emergency extracorporeal shock wave lithotripsy (ESWL) on the short-time outcome of symptomatic ureteral stones. Eur Urol 47(6):855–859CrossRefPubMed
22.
Kumar A, Mohanty NK, Jain M, Prakash S, Arora RP (2010) A prospective randomized comparison between early (< 48 h of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol 24(12):2059–2066CrossRefPubMed
23.
Uguz S, Senkul T, Soydan H, Ates F et al (2012) Immediate or delayed SWL in ureteric stones: a prospective and randomized study. Urol Res 40(6):739–744CrossRefPubMed
24.
Choi HJ, Jung JH, Bae J, Cho MC, Lee HW, Lee KS (2012) Usefulness of early extracorporeal shock wave lithotripsy in colic patients with ureteral stones. Korean J Urol 53(12):853–859CrossRefPubMedPubMedCentral
25.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
26.
Deliveliotis C, Chrisofos M, Albanis S et al (2003) Management and follow-up of impacted ureteral stones. Urol Int 70:269–272CrossRefPubMed
27.
Mueller SC, Wilbert D, Thueroff JW, Alken P (1986) Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience and experimental findings. J Urol 135:831–834CrossRefPubMed
28.
Cummings JM, Boullier JA, Izenberg SD, Kitchens DM, Kothandapani RV (2000) Prediction of spontaneous ureteral calculous passage by an artificial neural network. J Urol 164(2):326–328CrossRefPubMed
29.
Parr NJ, Pye SD, Ritchie AW, Tolley DA (1992) Mechanisms responsible for diminished fragmentation of ureteral calculi: an experimental and clinical study. J Urol 148(3 Pt 2):1079–1083CrossRefPubMed
30.
Al-Ghazo MA, Ghalayini IF, Al-Azab RS et al (2011) Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study. Urol Res 39(6):497–501CrossRefPubMed
31.
Zargar-Shoshtari K, Anderson W, Rice M (2015) Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int 115(6):946–950CrossRefPubMed
32.
Ouzaid I, Al-qahtani S, Dominique S et al (2012) A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients’ selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study. BJU Int 110(11 Pt B):E438–E442
33.
Panesar SS, Bhandari M, Darzi A, Athanasiou T (2009) Meta-analysis: a practical decision making tool for surgeons. Int J Surg 7(4):291–296CrossRefPubMed
34.
Zwahlen M, Renehan A, Egger M (2008) Meta-analysis in medical research: potentials and limitations. Urol Oncol 26(3):320–329CrossRefPubMed
35.
De Sio M, Autorino R, Quarto G et al (2007) A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter. BJU Int 100(5):1137–1141PubMed
36.
37.
Hollingsworth JM, Norton EC, Kaufman SR, Smith RM, Wolf JS Jr, Hollenbeck BK (2013) Medical expulsive therapy versus early endoscopic stone removal for acute renal colic: an instrumental variable analysis. J Urol 190(3):882–887CrossRefPubMed
38.
Dauw CA, Kaufman SR, Hollenbeck BK et al (2014) Expulsive therapy versus early endoscopic stone removal in patients with acute renal colic: a comparison of indirect costs. J Urol 191(3):673–677CrossRefPubMed
39.
Monga M (2014) When, for how long and in whom should medical expulsive therapy be used? J Urol 191(3):581CrossRefPubMed
Metadata
Title
Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies
Authors
Davide Arcaniolo
Marco De Sio
Jens Rassweiler
Jilian Nicholas
Estevão Lima
Giuseppe Carrieri
Evangelos Liatsikos
Vincenzo Mirone
Manoj Monga
Riccardo Autorino
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Urolithiasis / Issue 6/2017
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI
https://doi.org/10.1007/s00240-017-0960-7

Other articles of this Issue 6/2017

Urolithiasis 6/2017 Go to the issue

Original Paper

Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk?

Original Paper

Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy

Original Paper

Stress–stones–stress–recurrent stones: a self-propagating cycle? Difficulties in solving this dichotomy

Original Paper

Prevalence of renal uric acid stones in the adult

Original Paper

Comparison of supine and prone positions for percutaneous nephrolithotomy in treatment of staghorn stones

Original Paper

The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial