In Situ extracorporeal shock-wave lithotripsy as a primary treatment for ureteral stones.
BACKGROUND
The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels.


METHODS
We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle, and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were give individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded.


RESULTS
Complete stone clearance was achieved in 152 patients (91.6%) after an average of 10.2 days (range 1280. The average treatment rate was 1.3 sessions per patient. As a whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter.


CONCLUSIONS
We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option.
Maghraby
Hisham
H
Department of Urology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates, hishmag@hotmail.com.