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.
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/)
Time to lithotripsy is strongly associated with SFR followingSWL. SWL in an urgent care setting does not improveSFR if it is performed within 1 month, while time toSWL > 2 months reduces the likelihood of stone-free status.
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.
we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.
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.
Double pigtail ureteric stent placement appears to be unnecessary in procedures considered ‘uncomplicated’ by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements.