Extracorporeal Shockwave Lithotripsy Vs Urerteroscopy in The Treatment of Upper Ureteric Stones

Abstract

There are two main options for the intervention which are usually used for the treatment of calculi in the upper ureters and these are: extra corporeal shock wave lithotripsy (ESWL) and the lithotripsy by ureteroscope.Till now,there is controversy regarding which method is the most optimum in the treatment of calculi in the upper ureters.In this study we try to compare both modalities of treatment and which option consider the first-line treatment for upper ureteric calculi.From Jan. 2013 to Jan. 2014,one handered patients (54 males and 46 females) with single, unilateral upper ureteric stone size from (6-18 mm) treated in Al hilla teaching hospital are included in this randomized prospective study.The choice certain method for treatment was based on the clinical state of the patients and patients’ choice.Fifty (31 males and 19 females) patients are treated by ESWL, while the other fifty (23 males and 27 females) patients treated by ureteroscopy.Patients treated with ESWL achieved a 80% overall SFR with a 30 % auxiliary procedure rate. While Complications occur in 8% of cases who are treated by ESWL. Regarding group of patients treated with URS had a 92% SFR with an additional procedure rate of 28% While Complications occur in 18% of patients treated with ureteroscopy. (For ESWL group, the need of auxiliary procedures and complication rate are more common where stone size <1cm.Where as in ureteroscope group, the need of auxiliary procedures are higher for those with stone size>1cm. but the complication rate is still higher in patients with stone size <1cm.So in the urological centers in which both modalities of treatment are present, ESWL is the preferable option for treatment of patients with single upper stone in the upper ureterof ≤1 cm while ureteroscopy used for patients had stones of >1 cm.