title: A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience.
abstract: OBJECTIVE
  The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures.
  
  
  METHODS
  Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications.
  
  
  RESULTS
  There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21).
  
  
  CONCLUSIONS
  Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.
authors.affiliation: Department of Urology, Vardhman Mahaveer Medical College and Safdarjang Hospital , New Delhi, India .
authors.forename: Anup
authors.initials: A
authors.lastname: Kumar
authors.forename: Biswajit
authors.initials: B
authors.lastname: Nanda
authors.forename: Niraj
authors.initials: N
authors.lastname: Kumar
authors.forename: Rohit
authors.initials: R
authors.lastname: Kumar
authors.forename: Pawan
authors.initials: P
authors.lastname: Vasudeva
authors.forename: Nayan K
authors.initials: NK
authors.lastname: Mohanty
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008096:Lithotripsy / Q000379:methods*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D019233:Retreatment; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*