The AUA/EAU guidelines suggest MET as a reasonable treatment choice in select patients. Previous studies have demonstrated a significant benefit in stone expulsion rates with the use of MET. A review of the data suggests greater success rates occur with the use of alpha antagonist compared to calcium channel blockers. The use of MET is not limited to just those patients attempting passage of calculi without other interventions; there is also an advantage to MET in those subjects treated with other modalities (i.e. SWL and ureteroscopy). Even with multiple studies demonstrating the benefits of MET, it still is underutilized as a treatment modality. Education in the hospital setting appears to be beneficial in changing practice behaviors. MET may reduce medical costs and prevent unnecessary surgeries and the associated risks.
Only a minority of patients with ureteric calculi require surgical intervention. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET initially. The trial period may be extended up to 12-weeks depending on the control of symptoms and downward movement of the stone.
The SAV value is an independent predictor of the success of ESWL and a useful tool for planning stone treatment. Patients with a SAV P956 HU are not ideal candidates for ESWL. The inclusion criteria for ESWL of stones with a SAV <500HUcan be expanded with regard to stone size, site, age, renal function and coagulation profile. In patients with a SAV of 500–1000 HU, factors like a body mass index of >30 kg/m2 and a lower calyceal location make them less ideal for ESWL. ª 2014 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.
ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning. 2016 Arab Association of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/)
The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.
In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.
Post‑PCNL complications are more commonly found in patients with history of preoperative UTI, previous history of renal surgeries, large stone burden, operative procedure more than 90 min, and presence of residual calculi.
Percutaneous nephrolithotomy is a safe and effective treatment for renal stone disease. Body mass index does not affect the success or complication rate in PNL.
The absence of staghorn calculi and a no or mild hydronephrosis were related to an increased risk of post-percutaneous nephrolithotomy severe bleeding complications.
Each percutaneous renal guidance techniques has its advantages and disadvantages and no single technique is ideal in all circumstances. The two most commonly used modalities are ultrasonography and fluoroscopy. Color Doppler ultrasound, an addition to B-mode ultrasound guidance, can help avoid vascular injury, resulting in decreased intraoperative and postoperative hemorrhage. CT guidance is only used for access in complicated cases. MRI and robotic-assisted guidance are in their infancy and need more research. Endoscopic guide can improve the safety of renal access, but the cost, and experience of the operators need to be considered.
In relation to stone removal, sufURSs were found to be comparable to rfURS, and no compromising complications were found. However, the results should be treated with caution due to limitations related to the small number of studies included in the analysis.
