Extracorporeal shock wave lithotripsy in the treatment of ureteric stones: experience from Tawam Hospital, United Arab Emirates.
BACKGROUND
The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones.


METHODS
A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of the 99 patients, 20 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size, and number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A (< or =10 mm) and B (11-20 mm).


RESULTS
The overall clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (< or =10 mm) stones was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the mid-ureteric stones was 92.3%. Forty-nine patients had lower ureteric stones. The overall clearance rate for the lower ureteric stones was 69.3%.


CONCLUSIONS
ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without any need for anesthesia or any pretreatment intervention, it should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance rate for small stones (< or =10mm) in the lower third of the ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low with a high retreatment rate, and ureteroscopy as primary treatment modality would be more preferable.
Ghafoor
Mohammad
M
Department of Surgery, Urology, Division, Tawam Hospital, Al-Ain, Abu Dhabi, United Arab Emirates.
Halim
Anwer
A