Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones.

OBJECTIVES: To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. PATIENTS AND METHODS: Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. RESULTS: At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter <8 mm were associated with a stone-free rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). CONCLUSIONS: The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge.

OBJECTIVES: To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer. MATERIALS AND METHODS: We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented. RESULTS: There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months. CONCLUSION: EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.