INTRODUCTION: The purpose of the study was to assess the safety and efficacy of extracorporeal shockwave lithotripsy (ESWL) versus a semirigid ureteroscope with a lithoclast for treatment of large proximal ureteral stones.
METHODS: The participants were 147 patients with large (> 1 cm) upper ureteral stones. ESWL and ureteroscopy were performed for 71 and 76 patients, respectively. The mean stone sizes and standard deviations (SD) were 1.34 cm (SD = 0.03) for the patients receiving ESWL and 1.51 cm (SD = 0.04) for the patients receiving ureteroscopy. There were no significant group differences in stone size (P = .604). ESWL was performed under intravenous sedation with a Siemens modularis litho vario lithotripter. Ureteroscopy was performed under spinal anesthesia with a 7.5 Fr semirigid ureteroscope and lithoclast.
RESULTS: At the 1-month evaluation, 41 out of 71 patients (58%) were stone free after the initial ESWL and 70 out of 76 patients (92%) were stone free after ureteroscopy. The group difference in the stone-free rate was statistically significant (P = .003). The stones were accessible in 72 of the 76 patients (95%) having ureterscopy. Stone fragments were available for analysis from 23 patients receiving ESWL and 70 patients receiving ureteroscopy. The majority of stones in both groups were composed of calcium oxalate dihydrate (COD). No major complications were encountered in either group.
CONCLUSIONS: The present study demonstrates that ureteroscopy with a lithoclast can be considered an acceptable treatment modality for large proximal ureteral calculi. It can be used as an initial treatment for large proximal ureteral stones.
KEYWORDS: Ureteroscopy; Extracorporeal shock wave lithotripsy (ESWL); Proximal ureter; Lithoclast
CORRESPONDENCE: Ehab Rifat Tawfiek MD, Department of Urology, El Minia University Hospital, Elminia 16666, Egypt ( ).
CITATION: Urotoday Int J. 2010 Feb;3(1).
doi:10.3834/uij.1944-5784.2010.02.03