Optimal Therapy for the Distal Ureteral Stone: Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy

Abstract

Extracorporeal shock wave lithotripsy (ESWL not equal to) is the optimal therapy for renal calculi less than 2 cm. in diameter and for proximal ureteral calculi. Controversy continues over the initial approach to distal ureteral calculi (that is below the bony pelvis): in situ ESWL versus ureteroscopy. Since February 1990, 76 distal ureteral calculi were treated at our institution using either in situ ESWL (Dornier HM3 ESWL with a Stryker frame modification in 27 patients or Siemen's Lithostar electromagnetic ESWL in 22) or ureteroscopy (27 patients). Patient age and stone size were similar among the groups. All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Stone-free rates were 96% for the HM3 device, 84% for the Lithostar and 100% for ureteroscopy. Retreatment was required in 3 Lithostar cases (14%) and 1 HM3 case (4%). When compared to ESWL ureteroscopy for distal ureteral stones was more time-consuming, entailed routine placement of a ureteral stent, often required general anesthesia, more often led to hospitalization and doubled the convalescence period. From a cost standpoint, ESWL on an HM3 unit was a few hundred dollars more expensive than ureteroscopy. In summary, we believe that in situ ESWL provides optimal first line therapy for distal ureteral calculi, while ureteroscopy is better reserved as a salvage procedure should ESWL fail.

Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia

“…4) corresponded to a reduction from Aus$ 4748 to Aus$ 2374 per patient, albeit that such values do not consider changes in resource use per inpatient-day. These outcomes are generally consistent with results of other population-based research [16,17] and clinical trials of the cost-effectiveness of the noninvasive and minimally invasive treatment methods [10][11][12][13][14]. The third benefit has been the increased chance of renal preservation.…”

“…That ESWL is used to treat most calculi in the upper urinary tract is not surprising, given that it has consistently out-performed even minimally invasive endourological procedures in clinical trials of costeffectiveness [10][11][12][13][14]. Moreover, patients prefer to avoid surgery in the treatment of stone disease, with ESWL being perceived by them as the most desirable treatment option [15].…”

Extracorporeal Shock Wave Lithotripsy in the Treatment of Ureteric Stones: Experience from Tawam Hospital, United Arab Emirates

“…Depending on the availability of the equipment and expertise, one or the other therapy is given the priority. The success rate for ESWL treatment of distal ureteral calculi varies from 53%-96%, [14][15][16] and re-treatment rate varies from 10%-30%. 17 The clearance rate for distal ureteral stones treated with ESWL is significantly affected by the stone size.…”

“…Ureteroscopy as a primary treatment modality for distal ureteral calculi is highly effective, with reported success rates in excess of 90% in different reported studies. 14,19,20 The disadvantage of ureteroscopy is that it is an invasive procedure and requires general or regional anesthesia. Added to this is the fact that it has a 0.5%-10% complications rate.…”

Comparison of ureterorenoscopic lithotripsy and extracorporeal shock wave lithotripsy in the management of distal ureteral stones

“…Her iki yöntem içinde yüksek başarı ve düşük komplikasyon oranları bildirilmektedir 8,9 . Buna ek olarak, 5 mm'den küçük taşların %68'i ve 5 mm'den büyük taşlarında %47'si kendiliğinden düşmektedir 12 . Prospektif, randomize bir çalışmada distal üreter taşı olan 64 hasta değerlendirilmiş; ESWL ve ÜRS sonrası kontrollerini tamamlayan hastaların tamamında taşla-rın giderildiği bildirilmiştir 8 .…”