Extracorporeal shock wave lithotripsy and transureteral lithotripsy in the treatment of impacted lower ureteral calculi

ABSTRACT

We compared the efficacy of extracorporeal shock wave lithotripsy [SWL] with ureteroscopy followed by transureteral lithotripsy [TUL] for the treatment of impacted distal ureteral calculi. A total of 96 patients with solitary impacted distal ureteral calculi were assigned into 2 groups of treatment with SWL [42 patients] and TUL [54 patients] with a 6.9-F semirigid ureteroscope. Characteristics of the patients and the calculi, treatment parameters, clinical outcomes, and patients' satisfaction were assessed for each group as well as efficiency quotient. Demographic characteristics of the patients in the 2 groups were similar as well as the sizes of the calculi. The stone-free rate, 2 months postoperatively, was 71.4% in the patients of the SWL group and 88.9% in those of the TUL group. The efficiency quotient was 56% and 81% for the SWL and TUL groups, respectively [P =.004]. Retreatment rate was 26.2% [11 patients] and 9.3% [5 patients] for the SWL and TUL groups, respectively [P =.027]. Thirty patients in the SWL group [71.4%] and 52 in the TUL group [96.3%] were satisfied with their treatment [P =.001]. There were no major complications in neither of the groups. Minor complications [pain and hematuria] were more common in the TUL group. Based on the results of this study, TUL seems to be more effective than SWL in the treatment of impacted lower ureteral calculi sized smaller than 12 mm, and patients are more satisfied with this treatment method: