In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

Abstract

Background:The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. Materials and Methods: We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle, and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded. Results: Complete stone clearance was achieved in 152 patients (91.6%) after an average of 10.2 days (range 1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However, the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. Conclusion:We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option.