Category: Clinical Stones: SWL

MP9-16 - Extracorporeal shock wave lithotripsy in the management of distal ureteral calculi

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Current American Urological Association guidelines recommend ureteroscopy as primary management of distal ureteral stones and shock wave lithotripsy (SWL) as a secondary option. Utilization of SWL in the management of nephrolithiasis in North America has decreased. We hypothesized that SWL continues to be an effective option in the management of distal ureteral calculi and studied data from our center in patients who received SWL for distal ureteral stones. 


Methods :

A retrospective review was performed of patients treated initially with SWL for distal ureteral calculi between 2011 and 2017 at this institution. The success rate of SWL was assessed via radiologic imaging and if subsequent procedures were required to render patients stone free.


Results :

Operative note and chart review identified 78 patients who presented with distal ureteral stones and were treated with SWL as the initial form of management. Average patient age was 51.65 years, average BMI 27.5 and mean stone size 6.37 mm. Of these patients, 75.6% (n=59) were stone free and required no subsequent procedures. Twelve patients (15.4%) required repeat SWL to render them stone free; eight (10.2%) underwent ureteroscopy following failed SWL.


Conclusions :

One SWL procedure offers a stone free rate of 75.6% and after 2 procedures, offers a 89.2% stone free rate.  Only 10.2% of patients undergoing SWL at our centre required salvage ureteroscopy. SWL is an effective modality in the treatment of distal ureteral stones.

Kymora B. Scotland

Endourology Fellow
University of British Columbia
Vancouver, British Columbia, Canada

Gholamreza Safaee Ardekani

Vancouver, British Columbia, Canada

Khatereh Aminoltejari

Vancouver, British Columbia, Canada

Thomas Grgic

Vancouver, British Columbia, Canada

Justin Chan

Vancouver, British Columbia, Canada

Ryan Paterson

Vancouver, British Columbia, Canada

Ben H. Chew

Associate Professor, Department of Urologic Sciences
University of British Columbia
Vancouver, British Columbia, Canada

Dr. Chew is a urologist and the Director of Clinical Research at the Stone Centre at Vancouver General Hospital and an Associate Professor of Urology at the University of British Columbia in Vancouver, Canada. His main interests lie in the treatment and research of the pathophysiology of kidney stone disease. His research focus includes metabolic stone disease as well as biomaterials used in the urinary tract for ureteral stents. He has worked on various stent designs, stent coatings and drug-eluting ureteral stents to try and improve the quality of life for patients with kidney stone disease. He continues work on a degradable ureteral stent and has completed the first-in-human trials. Current studies include attempting to understand second messenger systems that are activated within the kidney and ureter once a ureteral stent has been placed. These could be exploited as future therapeutic targets for new drug eluting ureteral stents or designs to reduce symptoms.
He has authored over 80 peer-reviewed manuscripts and book chapters. He is a member of the Endourologic Disease Group for Excellence (EDGE) research consortium (www.endoedge.net) and the Wisconsin Quality of Life (WISQoL) research consortium. Dr. Ben Chew is also the Chair of Research for the Endourology Society. The role of the Research Chair is to facilitate and help improve research for the entire society.