Extracorporeal Shockwave Lithotripsy vs Ureteroscopy in the Treatment of Lower Ureteral Stones

Back, Chol Jong; Lee, Chung Bum; Cho, Dae Haeng

Abstract

PURPOSE: To determine the efficacy and outcome of extracorporeal shock-wave lithotripsy (SWL) compared with ureteroscopy (URS) in the treatment of lower ureteric calculi.
MATERIALS AND METHODS
The records of patients treated primarily by SWL and URS were analysed retrospectively. Treatment with SWL included 198 patients (103 men and 95 women). All patients received 2500-3000 shocks waves at a mean energy setting of 16-20kV. URS was used in 194 patients (91 men and 103 women), with 7Fr, 8Fr, 9.5Fr rigid Storz ureteroscope. All ureteroscopies were performed with the patient under general or spinal anesthesia. The outcome was assessed by stone-free rates, retreatment rates, auxiliary treatment, Efficiency quotient (EQ), complications.
RESULTS
SWL and URS for lower ureteric calculi resulted in a success rate 75.3% and 95.8%, respectively. Including the number of auxiliary procedures, we calculated the Efficiency Quotient (EQ) as 66.6 for SWL and 72.3 for URS. The mean treatment time for SWL was 30 minutes and for URS 38.1 minutes. General anesthesia was more frequently needed in URS patients. Complications occurred more often in the URS group. These were mostly mild, and all could be treated with a double-J stent, antibiotics, or analgesics. A lower stone-free rate was achieved in patients with larger(> OR = 10mm) stones (56.9% vs 82.9%) for smaller stones (<10mm) in the SWL group and 90.0% vs 97.9% for smaller stones in the URS group. Compared with SWL, URS was more time consuming; entailed placement of a ureteral stent and more often led to hospitalization. On the other hand, stone clearance was rapid after URS.
CONCLUSIONS
The stone-free rate after URS is much higher than after SWL. Our study demonstrates that URS is highly effective treatment option for lower ureteral stones.