[Distal ureteral lithiasis. ESWL versus ambulatory URS].
OBJECTIVE
To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000).


METHODS
Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures.


RESULTS
Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL.


CONCLUSIONS
There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.
Miján Ortiz
J L
JL
Servicio de Urología, Hospital Universitario San Cecilio, C/Dr. Oloriz, 16 18012 Granada, España.
Gutiérrez Tejero
F
F
López Carmona
F
F
Nogueras Ocaña
M
M
Arrabal Martín
M
M
Zuluaga Gómez
A
A
D000553:Ambulatory Care; D006801:Humans; D008096:Lithotripsy; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy