Ureteral calculi: treatment options under advanced technology

Choo, Myung Soo; Kim, Soo Woong; Lee, Eun Sik; Paick, Jae Seoung; Kim, Si Whang

Abstract

To determine the optional and objective criteria for choosing the appropriate treatment modality or ureteral calculi. we reviewed 210 patients (215 ureteral calculi) initially treated with expectation (78 calculi), ESWL (82 calculi). ureteroscopic removal (31 calculi). stone basket (7 calculi) and surgery (17 calculi) and the results of each treatment were compared. N 78 calculi treated with expectation 58 (74.4% ) passed spontaneously. The duration of 50% and 75% cumulative spontaneous passage (CSP) of proximal ureteral calculi (<6 mm) were 3 weeks and l3 weeks, whereas the duration of 25% CSP of proximal ureteral calculi (> or =6 mm) were 5 weeks (p=0.0087). The duration of 50% and 75% CSP of distal ureteral calculi (<7 mm) were S weeks and S weeks. whereas the duration of 25% and 50% CSP of distal ureteral calculi (> or =7 mm) were 4 weeks and 11 weeks (p=0.01 75). The overall success rate of ESWL was 88.5% and the success rates of upper. middle and lower ureteral calculi were 92.2%. 70.6% and 94.7%. The duration of passage of calculi fragmented by ESWL was 1 to 16 weeks (mean: 4 wks). The overall success rate of ureteroscopic removal was 87.5% and the rate increased to 93.1% when only lower ureteral calculi were included. Stone basket was successful in 4 calculi out of 7. In conclusion, it is preferable to treat the proximal ureteral calculi smaller than 6mm and distal calculi smaller than 7mm with expectation until 3 months and 5 weeks, respectively. Otherwise ESWL is appropriate for proximal ureteral calculi and ureteroscopic removal for lower ureteral calculi. Although advanced technology for the management of ureteral calculi has been developed, traditional therapy has the proper role in contemporary practice.