title: Second in situ extracorporeal shock wave lithotripsy in not disintegrated ureteral stones is preferred to retrograde manipulation.
abstract: In this study we tried to determine the optimal treatment of upper ureteral stones which are not disintegrated by the first extracorporeal shock wave lithotripsy (ESWL) and to analyze the cost-benefit ratio of retrograde manipulation into the renal pelvis. 180 patients with an upper ureteral stone were treated by ESWL in situ. 40 patients needed a retreatment and were randomized for retrograde manipulation before ESWL or ESWL in situ without a prior manipulation. In both the in situ group and in the push-and-smash group, the stone-free rate was 75%. In stones < 8 mm, the disintegration rate was higher after retrograde manipulation into the renal pelvis and inserting a DJ catheter. In conclusion, ESWL in situ is the optimal treatment for all patients with upper ureteral stones. We reserve retrograde manipulation before a second ESWL for stones < 8 mm. Routinely employed auxiliary procedures such as placement of a DJ catheter increase the costs significantly, without improving the results.
authors.affiliation: Department of Urology, Technical University of Aachen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Planz
authors.forename: H
authors.initials: H
authors.lastname: Borchers
authors.forename: P
authors.initials: P
authors.lastname: Mattelaer
authors.forename: G
authors.initials: G
authors.lastname: Jakse
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D008096:Lithotripsy / Q000191:economics; D014514:Ureteral Calculi / Q000628:therapy*; D014546:Urinary Catheterization