Indian Journal of Urology (Jan 2003)
Management of proximal ureteral stones - comparison of outpatient ureterolithotripsy with in-situ shock wave lithotripsy (SWL)
Abstract
Objectives: The aim of this study is to review the feasi-bility and effectiveness of ureteroscopy with intracorporeal lithotripsy under intravenous sedation on outpatient basis as a primary procedure in patients with proximal ureteral calculi and its comparison with in situ SWL. Methods: From January 2000 to December 2001, 56 patients with proximal ureteral calculi underwent uretero-lithotripsy and 32 patients underwent in situ shock wave lithotripsy (SWL). Ureterolithotripsy was performed with 8.0 Fr Wolf rigid ureteroscope and Swiss Lithoclast on daycare basis. Results: In patients managed with ureterolithotripsy, stone was successfully reached and fragmented in 47(83.93%) patients. Complete stone fragmentation and spontaneous passage occurred in 40 (71.4%)patients with single session. Seven (12.5%) patients required more than one session for complete clearance. JJ stent was required in 13(23.2%) patients. One case of ureteral perforation was managed successfully with JJ stent. In SWL group, 28 (87.5%) patients became stone free at 3 months. Seven-teen patients (53.2%) required retreatment and adjuvant procedure was done in 6 patients (18.7%). Conclusions: Ureterolithotripsy and in situ SWL are equally effective for proximal ureteral stone. Ureterolitho-tripsy for proximal ureteral calculi has high success rate with low morbidity. It can be done safely with intravenous sedation and local anesthesia. Ureteroscopic stone re-moval can be considered as primary approach in patients with proximal ureteral calculi reserving SWL for those who can afford it.
