Ureteroscopic therapy of "steinstrasse" after extracorporeal shock wave lithotripsy (ESWL)

We were interested in the efficacy and morbidity of the ureteroscopy (URS) in the treatment of "steinstrasse" after ESWL. From 1991 to 1996, 27 patien ts with "steinstrasse" were treated with a total of 32 ureteroscopic proced ures. The URS atone had a stonefree success rate of 43.7 % (n = 14). URS co mbined with ESWL was effective in 43.7 % (n = 14), leading to an overall su ccess rate of 87.4 %. In 4 cases (72.6 %) a second therapy was necessary ti n 3 cases a second URS + ESWL and in one patient a nephrectomy due to septi c pyonephrosis). The overall rate of auxiliary ESWL after URS was 53.1 %. M ean operating time was 72 minutes (20-180 min). The rate of complications w as 21.8 % (n = 7) and mainly due to ureteral perforations or postoperative fever but none suffered from late complications like ureteral stricture. Al l treated patients received a double-J-stent and antibiotics. The treatment of "steinstrasse" in the middle portion of the ureter proved to be more di fficult due to the anatomical position of the ureter and lasted in a longer operating time as the upper or distal "steinstrasse". The stone extraction and the lithoclast-lithotripsy alone or in combination were the most frequ ent used ureteroscopic procedures to eliminate stone fragments. The URS alo ne or in combination with the ESWL for the treatment of "steinstrasse" is a highly effective and safe approach.