Extracorporeal shock wave lithotripsy [ESWL] vs. ureterorenoscopic [URS] manipulation in proximal ureteric stone

ABSTRACT

To compare the stone free rate at one week after extracorporeal shoch wave lithotripsy [ESWL] and ureterorenoscopic [URS] manipulation for proximal ureteric stone [10 - 15 mm size]. Randomized controlled trial. Sindh Institute of Urology and Transplantation [SIUT], Karachi, from August 2010 to February 2011. One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using and 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, re-treatment rate, auxiliary procedure and complication rate were compared in each group. Success rate was 49.2% for ESWL and 57.8% for URS [p = 0.008]. The re-treatment rate was significantly higher in ESWL group than in URS group [40% vs. 11 and 18% in URS group]. Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterosrenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed