Objectives To determine the eBcacy and costs of extraureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, corporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid-and re-treatment rates, time to become stone-free, complications and costs. lower ureteric calculi. Patients and methods The records of patients treatedResults ESWL for mid-and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 compared with 96% and 99% for URS. However, patients treated with URS were stone-free within men and 21 women, mean age 52 years, range 23-78, 19 mid-and 44 lower ureteric calculi). All 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, achieved with stones of <50 mm2. The costs of URS were higher than those for ESWL. with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithoConclusions ESWL provides a noninvasive, simple and safe option for the management of mid-and lower tripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 mm fibre. All ureteroscopies ureteric calculi, provided that the stones are <50 mm2; larger stones are best treated by URS. were performed with the patient under general (n= 17) or spinal (n=87) anaesthesia in a mean treatment Keywords Ureteric calculi, extracorporeal shock-wave lithotripsy, ureteroscopy duration of 34 min. Stones were located in the mid-URS, and controversy about the optimal treatment

Ureteral stents reduce complications after extracorporeal shock wave lithotripsy (ESWL*) and contribute to successful stone passage. However, some reports note complications that are attributed to indwelling ureteral stents. We randomized 64 patients with large renal calculi (stone burden more than 200 mm.2) for in situ treatment or treatment with a prophylactically inserted stent. We used a 6Ch round stent with single-coiled ends or a triangular shaped stent with double-coiled ends. Patients were treated with a Siemens Lithostar lithotriptor. After 3 months we evaluated the results of treatment and post-ESWL morbidity. Of the in situ group (23 patients) treatment complications consisted of fever in 3, pyelonephritis in 1 and steinstrasse in 3. After 3 months 8 patients (35%) were free of stones. Of the stented population (41 patients) treatment complications consisted of fever in 7, pyelonephritis in 1, steinstrasse in 6 and bladder discomfort in almost half of the patients. Stent calcification and stent migration were also seen in 7 and 10 patients, respectively. Calcified stents had been in situ longer than noncalcified stents. The round stents migrated and calcified more often than the more rigid triangular stents. After 3 months 18 of the stented patients were stone-free (44%). We conclude that ureteral stents do not reduce post-ESWL complications. They are clearly associated with morbidity and do not improve stone passage markedly. Therefore, patients with a stone burden of more than 200 mm.2 should be treated in situ without auxiliary stenting.

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