title: Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy.
abstract: OBJECTIVE
  The best treatment modalities for large proximal ureteral stones are controversial, and include extracorporeal shock wave lithotripsy, ureterolithotripsy, percutaneous nephrolithotripsy, laparoscopic ureterolithotomy and open surgery. To the best of our knowledge extracorporeal shock wave lithotripsy, semirigid ureterolithotripsy and laparoscopic ureterolithotomy have not been previously compared for the treatment of large proximal ureteral stones. Therefore, we compared these modalities for the treatment of large proximal ureteral stones.
  
  
  METHODS
  A total of 48 patients with large proximal ureteral stones (greater than 1 cm) were prospectively randomized and enrolled in the study at a single institution between 2008 and 2010. Eligible patients were assigned to extracorporeal shock wave lithotripsy, semirigid ureterolithotripsy or laparoscopic ureterolithotomy.
  
  
  RESULTS
  Extracorporeal shock wave lithotripsy had a 35.7% success rate, semirigid ureterolithotripsy 62.5% and laparoscopic ureterolithotomy 93.3%. Stone-free rates showed a statistically significant difference among the groups (p = 0.005). Patients treated with laparoscopic ureterolithotomy vs semirigid ureterolithotripsy vs extracorporeal shock wave lithotripsy required fewer treatment sessions (mean ± SD 1.9 ± 0.3 vs 2.2 ± 0.6 vs 2.9 ± 1.4, p = 0.027). Neither major nor long-term complications were observed.
  
  
  CONCLUSIONS
  Proximal ureteral stone treatment requires multiple procedures until complete stone-free status is achieved. Laparoscopic ureterolithotomy is associated with higher success rates and fewer surgical procedures, but with more postoperative pain, longer procedures and a longer hospital stay. Although it is associated with the highest success rates for large proximal ureteral calculi, laparoscopic ureterolithotomy remains a salvage, second line procedure, and it seems more advantageous than open ureterolithotomy. At less well equipped centers, where semirigid ureterolithotripsy or extracorporeal shock wave lithotripsy is not available, it remains a good treatment option.
authors.affiliation: ABC Medical School, São Paulo, Brazil.
authors.forename: Antonio Corrêa
authors.initials: AC
authors.lastname: Lopes Neto
authors.forename: Fernando
authors.initials: F
authors.lastname: Korkes
authors.forename: Jarques Lúcio
authors.initials: JL
authors.lastname: Silva
authors.forename: Rodrigo Dal Moro
authors.initials: RD
authors.lastname: Amarante
authors.forename: Mario H Elias
authors.initials: MH
authors.lastname: Mattos
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.forename: Antonio Carlos Lima
authors.initials: AC
authors.lastname: Pompeo
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*