Extracorporeal Shockwave Lithotripsy Versus Ureteroscopy with Pneumatic Lithotripter in Treating Proximal Ureteric Stones

Abstract

Introduction: In recent years, ESWL (Extracorporeal Shockwave Lithotripsy) has proved a ate and easily reproducible method for treatment of calculi in upper urinary tract particularly above iline crest. Recently other modalities, particularly ureteroscopy with LASER lithotripsy and pneumatic lithotripsy (URS/ICPL) to treat the upper ureteric stone are very popular with less morbidities and good stones clearance. So, this study aims to compare the success rate, complications and efficiency of ESWL and URS/ICPL for the upper ureteral stones.

Methods: Patients were prospectively included the radio-opaque, solitary stones of 5 to 20 mm size without evident UTI (Urinary tract infection) located between the UPJ (Uretero- pelvic junction and S1 joint (Sacroiliac Joint) were included. Post procedural X-ray KUB was taken immediately in URS group and three weeks after ESWL group. Immediate and week after patients were assessed for complication. Disintegrations and clearance of the stones were assessed.

Results: Total of 78 patients were included in this study. Of which 46 were in ESWL and 32 were in URS/ICPL groups. Both groups had stones size and location of same size and site. In URS group majority had stone disintegration and clearance with proximal dislodgement of fragment or total stone of 21.9% Multiple sessions needed to clear the stones in ESWL group was 17.3%. DJ Stenting needed after the URS was in 75% of cases.

In ESWL group, disintegration immediately after the procedure was noted in 82.6% of cases. Auxillary services needed after the URS were ESWL, ureterolithotomy, second session URS. Majority did not have major complication in either group. In URS group 12.5% of patients had fever and UTI, treated with conventional antimicrobials. Ecchymosis at the site in ESWL were in 28 cases (p0001) Efficiency Quotient (EQ) for ESWL and URS were 31.8% and 18.2% respectively (p-0.18).

Conclusion: ESWL and URS/ICPL can be offered to patient for treatment of upper ureteric stone with minimal and acceptable complications ESWL can be done on daycare basis whereas URS/ACPL needed to be admitted in hospital.