title: Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy.
abstract: OBJECTIVE
  We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm.
  
  
  METHODS
  During the 2009-2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium-aluminum-garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures.
  
  
  RESULTS
  Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate (p= 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups.
  
  
  CONCLUSIONS
  In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases.
authors.affiliation: Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt.
authors.forename: Hamdy
authors.initials: H
authors.lastname: Aboutaleb
authors.affiliation: Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omar
authors.affiliation: Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt.
authors.forename: Shady
authors.initials: S
authors.lastname: Salem
authors.affiliation: Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elshazly
keywords: Calculi; lithotripsy; ureter; ureteroscopy