Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy.
BACKGROUND
The optimal treatment for distal ureteral calculi remains controversial. We present data from our institution to compare the efficacy of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with different lithotripsy modalities (URSL).


METHODS
From January 1994 to September 1997, 954 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar) in 524 patients and ureteroscopy (Wolf 8.0F instrument and Swiss Lithoclast) in 430 patients. Stone sizes and patient ages were similar in these two groups.


RESULTS
In the SWL group, the 3-month stone-free rate was 87%, and the effectiveness quotient (EQ) was 68.7%. In the URSL group, there was a 96% stone-free rate with an EQ of 92.1%. The SWL treatment was more expensive than URSL.


CONCLUSIONS
At our institution, ureteroscopy is more efficacious than SWL for the treatment of distal ureteral calculi. In selected patients who had stones >10 mm with evidence of impaction and severe colic pain, we strongly suggest that URSL is the best choice.
Chang
C P
CP
Department of Surgery, Changhua Christian Hospital, Taiwan. 63569@cch.org.ti
Huang
S H
SH
Tai
H L
HL
Wang
B F
BF
Yen
M Y
MY
Huang
K H
KH
Jiang
H J
HJ
Lin
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017048:Health Care Costs; D006801:Humans; D008096:Lithotripsy / Q000191:economics / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000191:economics