!"#$%#$% ! Management of Ureteral Calculi: Trends and Controversies Reza HamidizadehPGY-2 Department of Urologic Sciences Grand Rounds June 6, 2012 Objectives ! To review ! "Use of medical adjuncts in treatment of ureteral calculi "The role of early vs. late shockwave lithotripsy (SWL) "Management of patients who fail initial SWL "Data regarding efficacy of SWL vs. ureteroscopy (URS) "Contemporary results of SWL: Is the new technology any better? !"#$%#$% " Acknowledgements !Dr. Ben Chew !Dr. Ryan Paterson Urolithiasis !Lifetime risk 5-12% (13% men, 7% women) !50% recurrent renal colic within 5 years !7/1000 hospitalizations !2 million annual outpatient visits (USA) !$2.1 billion annual billing claims (USA) Bader et al, Eur Urol, 61: 764-772, 2012!"#$%#$% ' Management Options: !Observation / Medical expulsive therapy (MET) !Shock wave lithotripsy !Ureteroscopy 2007 EUA/AUA Nephrolithiasis Guideline Panel: Guideline for Management of Ureteral Calculi !10mm:"Most will require surgical intervention "SWL and URS both acceptable first line options Preminger et al, J Urol, 178: 2418-2434, 2007 !"#$%#$% ( Natural History!"## !"#$%'() *+",-."/ '( *+//,.0 !"(.- 123 4,55-6 +.$ 7+.-8 9::: ;:;< 1:=3 >#//+,. -" +58 =??9 :: 19??3 @(55 -" +58 =??=99< A; 1B;3 C+. !+D+0- -" +58 =??? =B9= 1