title: Supine transgluteal vs prone position in extracorporeal shock wave lithotripsy of distal ureteric stones.
abstract: OBJECTIVE
  To evaluate of efficacy of transgluteal (supine) approach for shock wave lithotripsy (SWL) in treatment of distal ureteric stones.
  
  
  METHODS
  This prospective, randomized, comparative study was conducted on 98 patients. Patients were randomly assigned into 2 groups: group A (n = 49; prone position) and group B (n = 49; supine position, transgluteal). Inclusion criteria included patients with radiopaque lower ureteric stones ≤10 mm. Exclusion criteria included radiolucent stones, stones >10 mm, the need for any auxiliary procedure, and any contraindication for SWL. Post-SWL evaluation included plain x-ray of kidney, ureter, and bladder at 2 weeks after treatment and then at monthly intervals after treatment for 3 months. Stone-free status was defined as no residual stone fragments visible on plain x-ray. Treatment failure was defined as persistence of stone fragments at 3 months or the need for ureteroscopy.
  
  
  RESULTS
  Stone-free rate after 1 treatment session was achieved in 44.9% and 75.5% for prone and supine positions, respectively. Proceeding to ureteroscopy, after failure of the second SWL session to clear the stones, was done in 34.7% and 8.2% for prone and supine positions, respectively. The overall success rate for SWL treatment in prone and supine groups was 65.3% and 91.8%, respectively (P <.001).
  
  
  CONCLUSIONS
  Transgluteal SWL while patient in supine position proved efficacy for treatment of distal ureteric stones. Larger group studies comparing the results of SWL in supine position with those of prone position and also with those of ureteroscopy may enrich our data to reach a consensus for the ideal management of distal ureteric stones.
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt. Electronic address: dr_emadsalem@yahoo.com.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Salem
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt.
authors.forename: Aref
authors.initials: A
authors.lastname: Maarouf
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdalla
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ragab
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt.
authors.forename: Ashraf M S
authors.initials: AM
authors.lastname: Shahin
mesh_terms: D000328:Adult; D002081:Buttocks; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D011446:Prospective Studies; D016683:Supine Position; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*