Ureteroscopy or extracorporeal shock wave lithotripsy for lower ureteric stone

The optimal treatment for distal ureteric stories still controversial. While most urologists offer extracorporeal shock wave lithotripsy [ESWL], others strongly prefer .ureteroscopy with or without mechanical fragmentation as the primary choice for treatment of lower ureteric stones. We present data from our department on these new modalities since 1998 to 2003. We treated 150 patients with distal ureteric calculi on Siemens modularis lithotriptor and 150 patients by ureteroscopy using forceps s, baskets or pneumatic lithoclast. Stone free rate three months post-ESWL was 90% with no complications. In ureteroscopic group of patients, the stone free rate was 95% with overall complications in 10 patients [6.7%] At our department, ureteroscopy with or without mechanical, fragmentation of lower ureteric stones is more efficacious method than ESWL, However the rarity of anaesthesia requirement and the absence of complications make ESWL as good as ureteroscopy. Our results may put ESWL as the second and in certain particular cases the first option in treatment of lower ureteric calculi

Options for treatment of upper ureteric stones when eswl is not available

During the period between July 1995 and January 1998, fifty patients with upper 2/3 ureteric calculi were subjected to endourological procedures using retrograde stone displacement or flushing back to the kidney. All patients were subjected to either PCNL for cases with successful retrograde flushing technique or PCN and antegrade renoureteroscopy for cases with failed retrograde flushing and in whom flushing was not attempted because of non visualized ureteric orifice. Thirty seven patients were male [74%] and thirteen were females [26%] with an average age of 41 years. The stones were located in the upper 1/3 ureter in 40 patients [80%] middle 1/3 in 9 patients [18%] and in both thirds in one patient [2%]. In seven patients ureteral stones were associated with renal stones which were removed during the same sitting. The overall stone clearance was 92%. The intra and post-operative complications were minimal. The operative time averaged 105 minutes for push and pull procedures and 120 min. for antegrade renoureteroscopy. Hospital stay for the successful cases ranged from 3-8 days with an average of 4 days