Salvage extracorporeal shock wave lithotripsy after ineffective distal contact laser lithotripsy


С. В. Головко
О. Ф. Савицький


Today, during the surgical intervention, it remains a problem that model of treatment of the stone of the distal ureter is optimal. Contact laser lithotripsy (CLL) has the advantage of extracorporeal shock wave lithotripsy (ECHL) as a method of choice in surgical treatment of distal ureteral stones. There are cases when CLL performed was ineffective, which required repeated fibro-ureteroscopy for extraction or lithotripsy of residual fragments of the stone.
The objective: to evaluate the efficacy of salvage ECHL in patients after ineffective primary CLL.
Patients and methods. From January 2007 to July 2017 in the Urology Clinic of the National Military Medical Clinical Center «GVCG» conducted 1756 EHCL with the help of the lithotripter
Siemens Modularis Variostar. The results of treatment of 29 patients who underwent remote lithotripsy of the stones of the lower third of the ureter after ineffective CLL were retrospectively evaluated.
Results. The average size of the stone in this group of patients was 7.3 mm. The average interval between CLL and ECHL was 14.1 days. The average number of strokes was 2712. All patients entered the ECHL session with the presence of a ureteral stent, which was installed immediately after the attempted CLL. In 24 (88.9%) patients, complete fragmentation of the stone was achieved after one ECHL session. Four other patients underwent additional surgical interventions.
The conclusion. Contact laser lithotripsy (CLL) is an effective method of treating stones in the distal ureter. However, in case of inefficiency, it is necessary to consider the possibility of using salvage minimally invasive and traditional surgical interventions. Extracorporeal lithotripsy is just a minimally invasive method, has similar successful results compared to CLL. Salvage extracorporeal shock wave lithotripsy is an effective option in patients to whom the use of CLL has been unsuccessful.


How to Cite
Головко, С. В., & Савицький, О. Ф. (2017). Salvage extracorporeal shock wave lithotripsy after ineffective distal contact laser lithotripsy. Health of Man, (3(62), 102–106.
Author Biographies

С. В. Головко, Клініка урології Національного військово-медичного клінічного центру «Головний військовий клінічний госпіталь» МО України, м. Київ

S.V. Golovko

О. Ф. Савицький, Українська військово-медична академія МО України, м. Київ

A.F. Savitsky


Segura JW. Ureteroscopy for lower ureteral stones. Urology 1993; 42: 356–357.

Stackl W, Marberger M. Late sequelae of the management of ureteral calculi with the ureterorenoscope. J Urol 1986; 136: 386–389.

Dretler SP, Weinstein A. A modified algorithm for the management of ureteral calculi: 100 consecutive cases. J Urol 1988; 140: 732–736.

Chaussi C, Fuchs G, Kahn R, Hunter P, Goodfriend R. Transurethral ultrasonic ureterolithotripsy using a solid-wire probe. Urology 1987; 29: 531–532.

Turk TMT, Jenkins AD. A comparision of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol 1999; 161:45–47.

Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for the distal ureteral calculi: A prospective randomized study. J Urol 1999; 162:1909–1912.

Hendrikx AJM, Strijbos WEM, De Knijff DW, Kums JJM, Doesburg WH, Lemmens WAJG. Treatment for extended-mid and distal ureter stones: SWL or ureteroscopy? Results of a multicenter study. J Endourol 1999; 13: 727–733.

Chaussy C, Schmiedt E, Jocham O, Brendel V, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 1982; 127: 417–420.

Miller K, Bubeck JR, Hautmann R. Extracorporeal shock wave lithotripsy of distal ureteral calculi. Eur Urol 1986; 12: 305–307.

Pardalidis NP, Kosmaoglou EV, Kapotis CG. Endoscopy vs. extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones: Ten years’ experience. J Endourol 1999; 13: 161–164.

Mogensen P, Andersen JT. Primary in situ extracorporeal shock wave lithotripsy for ureteral calculi. Scand J Urol Nephrol 1994; 157: 159–163.

Landau EH, Pode D, Lencovsky Z, Katz G, Meretyk S, Shapiro A. Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter. Urology 1992; 40: 132–136.

Zehntner C, Casanova GA, Marth D, Zingg ES. Treatment of distal ureteral calculi with extracorporeal shock wave lithotripsy: Experience with 264 cases. Eur Urol 1989; 16: 250–252.

Pearle MS, Nadler R, Bercowsky E, et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol 2001; 166:1255–1260.

Park H, Park M, Park T. Two-year experience with ureteral stones: Extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol 1998; 12: 501–504.

Srivastava A, Ahlawat R, Kumar A, Kapoor R, Bhandary M. Management of impacted upper ureteric calculi: Results of lithotripsy and percutaneous litholapaxy. Br J Urol 1992; 70: 252–257.

Netto NR Jr, Claro JFA, Lemos GC, Cortado PL. Treatment options of ureteral calculi: Endourology or extracorporeal shock wave lihotripsy. J Urol 1991; 146: 5–7.

Anderson KP, Keetch DW, Albala DM, Chandhoke PS, McClennan BL, Clayman RV. Optimal therapy for the distal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy. J Urol 1994; 152: 62–65.

Eden CG, Mark IR, Gupta RR, Eastman J, Shrotri NC, Tiptafi RC. Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on succes rates. J Endourol 1998; 12: 307–312.

Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: Current practise and long-term complications. J Urol 1997; 157: 28–32.

Singal RK, Razvi HA, Denstedt JD. Secondary ureteroscopy: Results and management strategy at a refferal center. J Urol 1998; 159: 52–55.

Hollenbeck BK, Schuster TG, Faeber GJ, Wolf JS Jr. Comparision of outcomes of ureteroscopy for ureteral calculi located above and below the pelvic brim. Urology 2001; 58: 351–356.

Kirkali Z, Esen AA, Hayran M, Gencbay A, Gidener S, Guven H, Gure A. The effect of extracorporeal electromagnetic shock-waves on the morphology and contractility of the rabbit ureter. J Urol 1995;154: 1939–1943.

Hofbauer J, Ludvic G, Marberger M. Do inefficient and futile attempts at treating ureteric stones lower the succes rate of definitive treatment? ( abstract). J Endourol 1995; 9 (suppl): S62.

Strohmaier WL, Schubert G, Resenkranz T, Weigl A. Comparision of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: A prospective study. Eur Urol 1999; 36: 376–379.

Trew, J. and Cornfield, J. (2017) A Comparison of Treatment Modalities in Renal and Ureteral Calculi. Open Journal of Urology, 7, 47–53.

Muhammet F., Omer G., Tolga et al. Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous? Can Urol Assoc J. 2015 Sep-Oct.

Weaver, Jack; Monga, Manoj. Extracorporeal shockwave lithotripsy for upper tract urolithiasis Current Opinion in Urology: March 2014. – Vol. 24 – Issue 2. – Р. 168–172.

Lu CH, Kuo JY, Lin TP et al. Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis. J Chin Med Assoc. 2017 Sep; 80(9): 551–557.