title: Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy.
abstract: OBJECTIVE
  We compared the safety and efficacy of ureteroscopy with intracorporeal holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) for proximal ureteral calculi.
  
  
  METHODS
  A total of 67 patients underwent 81 primary procedures, including in situ ESWL with a DoLi 50 lithotriptor (Dornier Medical Systems, Inc.) or ureteroscopy combined with holmium:YAG laser lithotripsy for proximal ureteral calculi.
  
  
  RESULTS
  Of the primary procedures 81 involved proximal ureteral calculi, including 35 done for calculi 1 cm. or greater. The initial stone-free rate in patients with calculi 1 cm. or greater was 93% for ureteroscopy combined with holmium:YAG laser lithotripsy and 50% for in situ ESWL. The efficiency quotient for treating proximal ureteral calculi 1 cm. or greater was calculated as 0.76 for ureteroscopic lithotripsy and 0.43 for ESWL. For proximal ureteral calculi less than 1 cm. the initial stone-free rate was 100% and 80% for ureteroscopic laser lithotripsy and ESWL, respectively. The efficiency quotient was calculated as 0.81 for ureteroscopic lithotripsy and 0.72 for ESWL for treating proximal ureteral calculi less than 1 cm. There were no major complications in either group and all procedures were performed on an outpatient basis.
  
  
  CONCLUSIONS
  Our study demonstrates that ureteroscopy combined with holmium:YAG laser lithotripsy is an acceptable treatment modality for all proximal ureteral calculi and excellent results are achieved for calculi 1 cm. or larger. Although the stone-free rate was better for smaller stones with ureteroscopic laser lithotripsy, efficiency quotients were similar. Therefore, ESWL should remain first line therapy for proximal ureteral calculi less than 1 cm. because of less morbidity, and a lesser anesthesia and analgesic requirement.
authors.affiliation: Department of Urology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Lam
authors.forename: Tricia D
authors.initials: TD
authors.lastname: Greene
authors.forename: Mantu
authors.initials: M
authors.lastname: Gupta
mesh_terms: D000328:Adult; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation; D017602:Lithotripsy, Laser / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy