Shock wave lithotripsy as a primary modality for treating upper ureteric stones: A 10-year experience.
OBJECTIVE
Shock wave lithotripsy (SWL) has been recommended as a first-line treatment for upper ureteric calculi in several studies with a success rate of 80-90%. Our aim is to present our retrospective data of treatment of upper ureteric stones with SWL as primary modality over a 10-year period and evaluate the factors affecting fragmentation and clearance.


METHODS
From February 1997 to March 2007, 846 patients with upper ureteric stones were treated with SWL as the primary modality. Age: 9-69 years, 546 males and 300 females, stone size: 7-22 mm. Pyuria in 132/846 with clinical infection 40/132, pre-SWL JJ stenting: 40/846 and anesthesia in 41/846 patients. Duration of symptoms: < 4 weeks- 780/846, >4 weeks- 66/846. Stone size: < 1 cm- 513/846, >1 cm-333/846. Workup: X-Ray KUB, Urine and Uro-USG. Intravenous urogram (IVU): 130/846. Intraoperative (C-arm) fluoroscopic imaging was used.


METHODS
colic-801/846, incidental-45/846. Criteria for clearance: symptomatic relief, X-ray and USG confirmation.


RESULTS
CLEARANCE RATE: < 1cm- 95.91% (492/513), >1 cm- 85.29% (284/333). Overall clearance rate: 91.73% (776/846). No clearance: 70/846 (8.27 %). In these, 59/70 underwent ureteroscopy, 8/70 percutaneous nephrolithotomy and 3/70 open ureterolithotomy for clearance. Post SWL complications were seen in 25 (3%) cases with septicemia in nine and stein strasse in 16 cases. Duration of symptoms < 4 weeks - 93.7% success (731/780), >4 weeks - 68.1% (45/66). Non-stented - 92% (744/806) success. Stented group-80% (32/40).


CONCLUSIONS
Best results with SWL as monotherapy for upper ureteric stones are achieved when stones are less than 1 cm in size, of short duration history and without indwelling stents. Overall success rate - 91.73%.
Padhye
Abhijit S
AS
Dr. Y. G. Bodhe, Dept of Urology; Maharashtra Medical Foundation and Maharashtra Medical Research Centre, 986 Senapati Bapat Road, Pune - 411 053, India.
Yadav
Pushkaraj B
PB
Mahajan
Pratikshit M
PM
Bhave
Ashish A
AA
Kshirsagar
Yogesh B
YB
Sovani
Yogesh B
YB
Bapat
Shivadeo S
SS