Ureteral Meatotomy as a Treatment of Steinstrasse Following Extracorporeal Shock Wave Lithotripsy

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Abstract
Sixteen per cent of the first 1,053 patients who were treated with extracorporeal shock wave lithotripsy (ESWL) at the University of Virginia required some type of post-ESWL ancillary procedure. Obstructive Steinstrasse was initially managed with ureteral meatotomy in 50 patients, 18 of whom were evaluated with voiding cystourethrography at least 2 months later. One-third of these patients had more than a 50% reduction in the length of the Steinstrasse, but more than half had vesicoureteral reflux on follow-up cystogram that was low grade (grade I or II) in all but one patient (grade III). Ureteral meatotomy is best used for the removal of a large leading fragment that is impacted in the ureteral orifice. Impacted sand without any large fragments can be managed with pulsed water irrigation through an end-hole catheter or with percutaneous renal drainage. A percutaneous nephrostomy protects the kidney and seems to increase the efficiency of ureteral peristalsis and the expulsion of particles.