title: Treatment of lower ureteral stones: extracorporeal shockwave lithotripsy or intracorporeal lithotripsy?
abstract: OBJECTIVE
  In this study, 1121 patients with lower ureteral stones were evaluated to compare the effectiveness of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with three different lithotripsy modalities.
  
  
  METHODS
  Of these patients, 726 were treated with SWL, whereas 430 underwent ureteroscopy, with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL), and electrohydraulic lithotripsy (EHL) performed in 125 (29.0%), 276 (64.2%), and 29 (6.8%) patients, respectively. Thirty-five patients underwent both types of treatment because of unsuccessful SWL therapy.
  
  
  RESULTS
  In the SWL group, the stone-free rate was 42.2% and the fragmentation rate was 59.5%. These values were 96.8% and 98.4% for PL, 89.4% and 90.5% for USL, 93.1% and 96.5% for EHL, respectively.
  
  
  CONCLUSIONS
  These data show that SWL was less effective than ureteroscopic lithotripsy (p < 0.001). The PL modality had the highest stone-free and fragmentation rate, and EHL had the highest complication rate (43.5%). Ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy is used, and PL is the most effective and least morbid approach.
authors.affiliation: Department of Urology, University of Gazi, School of Medicine, Ankara, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Biri
authors.forename: B
authors.initials: B
authors.lastname: Küpeli
authors.forename: K
authors.initials: K
authors.lastname: Isen
authors.forename: Z
authors.initials: Z
authors.lastname: Sinik
authors.forename: U
authors.initials: U
authors.lastname: Karaoğlan
authors.forename: I
authors.initials: I
authors.lastname: Bozkirli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy