Shockwave lithotripsy (SWL) for distal ureteric stones can be an effective alternative to ureteroscopy (URS) for selected patients, investigators reported at the European Association of Urology (EAU) 2022 annual meeting in Amsterdam, The Netherlands.

Guidelines from the American Urological Association recommend URS for the first-line treatment of distal ureteric stones, whereas EAU guidelines recommend either SWL or URS for first-line treatment, investigator Jennifer Bjazevic, MD, of Western University in London, Ontario, Canada, noted during an oral presentation.

Dr Bjazevic and colleagues studied 361 patients who underwent SWL for distal ureteric stones from October 2011 to November 2020 at medical centers in London, Ontario, Canada, Vancouver, British Columbia, Canada, Oxford, England, and Muscat Governorate, Oman. Patients had a mean age of 51.2 years, mean stone stone size of 6.7 mm, and mean body mass index (BMI) of 28.1 kg/m2.

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The treatment success rate after a single SWL session — the study’s primary outcome — was 68.4%, Dr Bjazevic reported.

Multivariate analysis identified larger stone size and older age as predictors of treatment failure, she said. Patients who had a successful treatment had a significantly smaller mean stone size compared with those who did not (6.37 vs 7.42 mm). The investigators found no significant association between BMI, sex, and treatment characteristics and treatment failure.

She explained that SWL has some advantages over URS. For example, SWL is well tolerated, does not require general anesthesia, and can be performed as an outpatient procedure.

The investigators concluded that SWL, despite having lower reported stone-free rates compared with URS, should be offered to patients as an option for distal ureteric stones, especially for patients who have failed conservative therapy or would prefer to avoid an endoscopic procedure.


Gabringa Berto FC, Razvi H, Bjazevic J, et al. Shockwave lithotripsy for distal ureteric stones: Real world outcomes from the Endourological Society T.O.W.E.R. research initiative. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0263.