ABSTRACT
Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones.Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric stones underwent 108 primary procedures and 19 ancillary procedures (total: 127) including in-situ ESWL (60 patients) using the Dornier MPL 9000 machine and ureteroscopy combined with Holmium:YAG laser lithotripsy (46 patients). Results: The overall stone-free rate was (93.75%) for cases subjected to uretero-scopy in combination with laser lithotripsy and (91.7%) for cases subjected to ESWL. For stones < 1 cm, the success rate was 100% in the laser and 95.65% in the ESWL group. For stones > 1 cm, the success rate was 90% in the laser and 78.6% in the ESWL group. For impacted stones, the success rate was 92.85% in the laser and 72.7% in the ESWL group. The EQ for the laser and ESWL groups was 0.86 and 0.73, respectively. The complication rate was 12.53% in the laser and 11.7% in the ESWL group. The average cost (in Egyptian pounds) was 1618.1 £E for Holmium: YAG laser treatment and 1069.1 £E for ESWL treatment. Conclusion: Apart from impacted stones and stones larger than 1 cm, ESWL is the first line of choice as a treatment modality for upper ureteric stones. However both ESWL and URS combined with holmium: YAG laser lithotripsy may be complementary to each other in treating upper ureteric stones