Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones.
OBJECTIVE
To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi.


METHODS
We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared.


RESULTS
The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017).


CONCLUSIONS
ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.
Turna
Burak
B
Department of Urology, Ege University Medical Faculty, Bornova, Izmir 35100, Turkey. burakturna@gmail.com
Akbay
Kaan
K
Ekren
Fatih
F
Nazli
Oktay
O
Apaydin
Erdal
E
Semerci
Bülent
B
Günaydin
Gürhan
G
Cüreklibatir
Ibrahim
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D017211:Treatment Failure; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*