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TREATMENT OPTIONS FOR UPPER URETERAL CALCULI (SIZE > 10 MM)

 

EXTRA-CORPOREAL LITHOTRIPSY

URETEROSCOPIC LASER LITHOTRIPSY

LAPAROSCOPIC SURGERY (KEY-HOLES SURGERY)

DESCRIPTION

Patient lies on the table of the machine. Shock waves will be delivered to the stone to make it broken

An ureteroscope is inserted through the urethra and up to the stone location. Laser beam will make the stone broken

Through 3 – 4 small holes at the back, surgeons use instruments to open the ureter, remove the stone, then close the ureter.

AFTER THE PROCEDURE

No catheter

An ureteral stent is left inside the ureter and will be removed 2 – 4 weeks after the operation

An ureteral stent is left inside the ureter and will be removed 2 – 4 weeks after the operation

ANESTHESIA

Sleeping pills

General anesthesia

General anesthesia

HOSPITALIZATION

Discharge 3 hours after the procedure

1 night hospitalization

2 nights hospitalization

SUCCESS RATE

Success rate (stone clearance): 60 – 70%
About 70 – 80% chance to repeat the procedure in a second session (2 weeks after) to get stone clearance

Success rate 90 – 95%
Failures due to:

  • Inability to access the stone location
  • Stone migration up to the kidney

Success rate 98 – 100%
Failures due to stone migration up to the kidney that requires open surgery to remove stone

SURGICAL COMPLICATIONS

  • Large fragments in ureter requires ureteroscopic removal: 5%
  • Hematuria, infection: 5%
  • Ureteral perforation requires surgical repair: 1%
  • Urinary infection: 1 – 5%
  • Post-op bleeding: 1 – 2%
  • Urinary infection: 1 – 5%

ADVANTAGES – DISADVANTAGES

  • Minimally invasive (+++)
  • Success (+)
  • Complications (+)
  • Cost (+)
  • Minimally invasive (++)
  • Success (++)
  • Complications (++)
  • Cost (++)
  • Minimally invasive (+)
  • Success (+++)
  • Complications (+)
  • Cost (+++)
Pelvic organ prolapse
Varicocelectomy
Treatment options for upper ureteral calculi (size > 10 mm)
Benign Prostatic Enlargement (Hyperplasia)
Bladder slings (TOT)
Prostate Cancer
Vasectomy
Semen Analysis
Prostate Biopsy
Erectile Dysfunction (ED)
Prostate Infection
Urinary Calculi
Varicocele
Over Active Bladder
Kidney Cancer
Bladder Cancer
Premature Ejaculation
Haematuria