title: What is the optimal treatment for lower ureteral stones larger than 1 cm?
abstract: OBJECTIVE
  To compare the treatment options for lower ureteral stones larger than 1 cm.
  
  
  METHODS
  The records of 449 patients with lower ureteral calculi larger than 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were treated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7%) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureterolithotomy (group 3). Eighty-seven (19.5%) patients underwent any of the two treatment modalities because of unsuccessful primary treatment.
  
  
  RESULTS
  The overall stone-free rates were 32.4, 90.9 and 95.3% for ESWL, PL and ureterolithotomy, respectively. These values were 84.4% for primary PL and 96.7% for primary ureterolithotomy. The re-treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups.
  
  
  CONCLUSIONS
  Pneumatic lithotripsy with ureteroscopy seems to be an appropriate treatment for larger ureteral stones. While ESWL can be tried as a first treatment option because of its noninvasive nature, lower success and higher re-treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.
authors.affiliation: Gazi University, School of Medicine, Department of Urology, Ankara, Turkey. urology@behcet.tip.gazi.edu.tr
authors.forename: B
authors.initials: B
authors.lastname: Küpeli
authors.forename: T
authors.initials: T
authors.lastname: Alkibay
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; D002648:Child; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy