An algorithm for the management of ureteral calculi.

We evaluated 158 patients with ureteral calculi (28 impacted in the ureteropelvic junction, 42 in the upper, 29 middle and 36 lower third of the ureter, and 23 in the intramural tunnel) treated by extracorporeal shock wave lithotripsy, percutaneous ultrasonic lithotripsy, ureteroscopic methods, chemolysis or surgery. Of the patients 92.5 per cent were treated successfully by endourological methods. Twelve patients (7.5 per cent) required an operation. Extracorporeal shock wave lithotripsy was successful in 61 per cent of the patients without placement of a ureteral stent and in 100 per cent in whom stent placement or stone dislodgement was successful. Ureteroscopic removal was successful in 52 of 56 patients with lower third and intravesical tunnel ureteral calculi. An algorithm for ureteral calculi management is developed, which emphasizes stent bypass and extracorporeal shock wave lithotripsy for upper third or ureteropelvic junction calculi, ureteroscopic removal or stent bypass with extracorporeal shock wave lithotripsy for middle third calculi, and ureteroscopic techniques for lower third and intramural tunnel calculi. Percutaneous ultrasonic lithotripsy, chemolysis and surgery are recommended as complementary methods.