Treatment Options for Lower Ureteral Calculi: Expectancy or Endourologic manipulations

Min, Seung Ki; Shin, Ki Yong

Abstract

To determine the optimal therapeutic approach for lower ureteral calculi at the hospitals which have not possessed ESWL, we reviewed 85 cases initially treated with expectancy for more than 7 days. Of 85 cases, 37 were treated with expectancy only and the remaining 48 cases received the endourologic manipulations such as stone basket and ureteroscopic removal. A total cumulative spontaneous passage rate at 3 weeks was about 52.9% and the possibility of spontaneous passage of remained stones at 3 weeks was not significant. The spontaneous passage rate was higher in the cases with the stones of small size (less than 6mm), smooth-round shape and without urinary tract obstruction than the other cases. 26 cases were treated with the stone basket and stone extraction rate was only 42.3%. The stone extraction rate was higher in the cases with the stones of smaller size (less than 4mm), irregular-speculated shape and with short duration of previous expectancy than the other cases. A total of 32 cases received the ureteroscopic manipulation and the success rate was 87.5%. Thus, we recommend initial expectancy for up to 3 weeks in the lower ureteral calculi smaller than 10 mm. And after this period, the positive and selective endourological manipulation considering the stone size, shape and expectant duration may be desirable in respect of treatment efficacy.