Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy

Publisher Website
Google Scholar
Abstract
In the application of extracorporeal shock wave lithotripsy for proximal ureteral and midureteral stones, both the in situ and the pushback or "push-bang" treatments are recommended. In our center, 47 patients (38 males, 9 females) with uncomplicated ureteral stones were randomized to one of these methods and evaluated after 3 months. The group having in situ treatment consisted of 23 patients and the group having the pushback treatment of 24 patients. All patients were treated with the Siemens Lithostar. In the in situ group, only seven patients needed intravenous analgesia or sedation. The average number of shock waves delivered was 3100. After 3 months, 21 patients (91%) were free of stones. No major complications were noted. In the pushback group, 15 patients (all males) needed epidural anesthesia and two intravenous analgesia or sedation. The pushback was successful in only 9 patients (37.5%); the average number of shock waves delivered was only 2000. Those nine patients were free of stones after 3 months. The pushback failed in 15 patients, and they were treated with the stones in situ. The average number of shock waves was 3100; 11 of the 15 (73%) were free of stones after 3 months. In the pushback group, one serious complication occurred: one patient suffered a severe headache after epidural anesthesia. Epidural anesthesia is mandatory for all men in this group. We conclude that, in spite of the higher number of shocks, in situ treatment of proximal and midureteral calculi is preferable to pushback, especially in men.