Clinical Experience of the Lower Ureteral Stones

Park, Seog Il; Yeum, Gyu Young

Abstract

Several therapeutic methods, expectant management, endourology and ESWL can be used in the treatment of ureteral calculi. In a retrospective analysis during a 3-year period, 96 patients showed spontaneous passage of stones. 164 patients treated with endourologic procedures and 168 who underwent ESWL with a Wolf Piezolith 2300 were analysed as to the success rate in stone removal, complication rate, anesthesia and hospitalization. The mean stone size was 5mm in the expectant management group and 6mm in both endourology and ESWL groups. 11mm was the mean size in the surgical group. Complete removal of all stone fragments was achieved in 52.5% of the expectant managed patients. The overall success rate were comparable with modalities which were 94.5% in endourology and 91.4% in ESWL and 100% in ureterolithotomy. The group treated endourologically had a better success rate but no significant difference to ESWL group. On the other hand, the group treated with ESWL had a shorter hospitalization, lower complication rate, no need for anesthesia. These observations showed that in situ ESWL provides a optimal first line therapy for distal ureteral calculi larger than 5mm, while ureteroscopy is better reserved as a salvage procedure should ESWL fail. Expectant management is more efficient for distal ureteral calculi less than 5mm.