Shock wave lithotripsy or ureteroscopy for the management of proximal ureteral calculi: an old discussion revisited.
OBJECTIVE
The goal of treating ureteral calculi is to achieve complete stone clearance with minimal patient morbidity. Shock wave lithotripsy and ureteroscopy have become standards of care for ureteral calculi. However, the optimal choice of treatment depends on various factors, including stone size, composition and location, clinical patient factors, equipment availability and surgeon capability. Indications for and outcomes data on shock wave lithotripsy and ureteroscopy for proximal ureteral calculi were reviewed to provide recommendations on the optimal treatment choice for managing symptomatic ureteral calculi.


METHODS
A systematic review was performed based on an English literature search using the MEDLINE database between 1997 and 2005. The key words used were proximal ureteral calculi, ureteroscopy and shock wave lithotripsy.


RESULTS
A total of 87 articles were identified, of which 33 were selected for inclusion. Shock wave lithotripsy and ureteroscopy provided an excellent stone-free rate (86% to 90%) for stones less than 10 mm, whereas for larger stones ureteroscopy achieved better outcomes vs shock wave lithotripsy (67% vs 73%). Ureteroscopy was preferred over shock wave lithotripsy in patients with pregnancy or bleeding diathesis.


CONCLUSIONS
Ureteroscopy provides optimal stone clearance in patients with proximal ureteral calculi more than 10 mm. It is also recommended in patients with contraindications for shock wave lithotripsy. In patients with smaller stones (less than 10 mm) shock wave lithotripsy may be considered a reasonable alternative with outcomes similar to those of ureteroscopy.
Kijvikai
Kittinut
K
Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Haleblian
George E
GE
Preminger
Glenn M
GM
de la Rosette
Jean
J
D005260:Female; D006474:Hemorrhagic Disorders / Q000150:complications; D006801:Humans; D008096:Lithotripsy; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy