Treatment of large proximal ureteral stones: extra corporeal shock wave lithotripsy versus semi-rigid ureteroscope with lithoclast.

PURPOSE: Assessment of safety and efficacy of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscope with lithoclast for treatment of large proximal ureteral stones.
MATERIALS AND METHODS: The study included 147 patients with large upper ureteral stones. SWL and ureteroscopy were performed in 71 and 76 patients respectively. Patients in the SWL group were treated with Siemens: - Modularis lithovario under intravenous sedation on an out patient basis. Patients in the ureteroscopy group were treated with (7.5 Fr) semi-rigid ureteroscope and lithoclast under spinal anesthesia on a day care basis.
RESULTS: Stone - free rate for in situ SWL was 58% (41 of 71) patients. For semi-rigid ureteroscope accessibility of the stones was 94% (72 of 76) and the stone free rate was 92% (70 of 76) No major complications were encountered in both groups.Mean stone size was 1.34 +/- 0.03 cm in the SWL group and 1.51 +/- 0.04 in the ureteroscopy group.
CONCLUSIONS: Our study demonstrates that ureteroscopy with lithoclast can be considered as acceptable treatment modality for large proximal ureteral calculi and can be considered as fist line for treatment of large proximal ureteral stones.