The Comparison of Efficacy of Ureteroscopic Removal and Shockwave Lithotripsy in Lower Ureteral Stones

Kim, Kyong Hun; Shim, Bong Suk

Abstract

PURPOSE: There still exists controversy as to the most appropriate treatment modality for lower ureteral stone; ureteroscopic removal of stone (URS) versus shockwave lithotripsy (SWL). So we compared clinical results of both procedures to help determine which is more appropriate as initial management for lower ureteral stones.
MATERIALS AND METHODS
We retrospectively reviewed 587 patients who had been treated for their lower ureteral stones at our institute. 184 patients were treated under the direct vision of ureteroscope using stone basket or Lithoclast and 403 patients were treated by SWL. We analyzed success rates and complication rates of each procedure.
RESULTS
Overall stone free rates were 95.7% with URS and 84.6% with SWL. In SWL group, stone free rate after third session was 88.3% when the stone was smaller than 10mm and 74.0% when the stone was larger than 10mm. But in URS group, the size of stones did not affect to stone free rate. And impaction of stone affected stone free rate. Stone free rates of impacted ureteral stones were 95.2% with URS and 63.8% with SWL. The complications of URS were found in 8.7% but all of them were successfully treated with ureteral stenting for 3 weeks or conservative treatment. While complications in SWL group were minimal.
CONCLUSIONS
In our study, URS and SWL were successful and safe treatment modality for lower ureteral stones. And we consider URS as the first line treatment modality when the stone is larger than 10mm or impacted.