Ureteroscopic Manipulation for Ureteral Calculi: Comparison with ESWL

Byeon, Seok Soo; Jeon, Seong Soo; Lee, Hae Won; Park, Eun Chan; Lee, Jin Haeng; Kwak, Cheol; Kim, Hyeon Hoe; Kim, Kwang Myeong; Paick, Jai Seung; Kim, Si Hwang

Abstract

Ureteroscopy has been used widely to remove ureteral calculi, especially distal ureter stones. Also extracorporeal shock wave lithotripsy (ESWL) has widened its applicability to ureter stones including distal ureter stones. In this study we tried to evaluate the exact role of ureteroscopic manipulation to get rid of ureter stones in the era of ESWL. Success rates and complications of 111 ureteroscopic stone removal procedures performed from December 1986 to May 1995 and those of another 369 patients managed with ESWL from May 1989 to May 1995 were analyzed. Success was defined as complete removal of the stones or residual stones less than 2 mm, immediate postoperatively in ureteroscopic manipulation and 2 weeks after ESWL. The success rate of the ureteroscopic manipulation was 38.9% (7/18), 46.2% (6/13) and 67.5% (54/80) in upper, middle and lower ureter stones, respectively. According to the size of the stone, success rate was 72.4% (21/29), 63.5% (40/63) and 14.3% (9/63) when it was less than 5 mm, 6 to 10 mm and larger than 10 mm. So the overall immediate postoperative success rate of ureteroscopic stone removal was 60.4%, and in another 8.9% of the patients the residual fragmented stones were expelled spontaneously in one month after the procedure. Complications were found in 9.9% of the procedures, including 5 mucosal avulsions and 2 ureteral strictures Success rate of the single session of ESWL was 64% without any differences regardless of the location of the stones in ureter, and it increased up to 88% when another 2 more sessions were tried. Success rate of the single session of ESWL according to the size of the stone was 91.7% (22/24), 67.9% (144/215) and 53.89S (70/130) in stones less than 5 mm, 6 to 10 mm and more than 10 mm, respectively. Complications were found in 3.4% of the patients, including 1.7% of steinstrasse and 1.4% of severe nausea and vomiting. From these observations we can conclude that it seems to be mandatory to renovate the indications of the ureteroscopic stone removal procedures in the era of ESWL.