Use of shockwave lithotripsy (SWL) for proximal ureteral stones can be expanded to stones up to 15 mm in diameter with acceptable success rates, researchers conclude.
Investigators at Shaheed Labbafinezhad Hospital and Shaheed Beheshti Medical University in Tehran enrolled 197 patients with a single 10-15 mm proximal ureteral stone, of whom 51 chose ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy (URSL) and 146 opted for SWL.
Of these patients, 11 in the URSL group and 20 in the SWL group did not finish three months of follow-up and were excluded from analysis, leaving 40 in the URSL group and 126 in the SWL group. Of the 40 URSL patients, 29 (72.5%) were stone free after three months, according to a report in Urology (2008;71:28-31).
The remaining 11 patients had residual stone fragments in the proximal ureter and underwent ballistic transurethral lithotripsy or laparoscopic ureterolithotomy as a salvage procedure. Of the 126 SWL patients, 99 (78.6%) were stone free at three months and 27 patients were not. Twenty-two of these 27 patients opted for a second session, and 21 of them became stone free. One patient required a third SWL session. The five patients who did not opt for SWL underwent ballistic transurethral lithotripsy. All became stone free. The stone-free rates and the need for a salvage procedure between the groups were not significantly different.
“In an era in which patient preference has a great influence on treatment planning,” the authors wrote, “the minimally invasive nature of SWL has resulted in patients preferring it to ureteroscopy even when warned that the stone-free rate might not be as great as that of URSL.”