The Efficacy of Extracorporeal Shock Wave Lithotripsy(ESWL) for Mid-ureter Stone

Shin, Joon Young; Shim, Bong Suk; Yoon, Hana

Abstract

PURPOSE: The majority of upper and lower ureteral stones are primarily treated by extracorporeal shock wave lithotripsy(ESWL), but the optimal treatment for ureteral stones overlying the pelvic bone(middle third of the ureter) remains unclear and controversial.
MATERIALS AND METHODS
From April 1999 to March 2003, out of 70 patients with stones in the middle third of the ureter, 62 who were followed up continuously were included in this study. Shock waves to the stones were delivered from the back because their pelvic bones were barriers for shock waves. We used third generation ESWL, Modulith SLX(R)(Storz, Germany). Patients who were treated primarily with ureterolithotomy or ureteroscopic stone removal were excluded from the study. The success and complication rates were analyzed.
RESULTS
The overall stone free rates were 88.7% with ESWL. Out of 62 stones, 33 were removed at the middle third of the ureter, 25 migrated to the distal ureter, and 4 that remained at the same site were removed by ureterolithotomy. Out of the 25 stones which migrated to the distal ureter, 22 were removed by repeated ESWL, but 3 required ureteroscopy for removal. Complications were shown in 6 patients: gross hematuria persisting more than 48 hours in 3, abdominal and flank pain in 1, UTI with fever in 1, and steinstrasse in 1.
CONCLUSIONS
In our study, ESWL provided satisfactory success rates even in the mid-ureteral stones. It is a noninvasive, simple and safe option for the management of stones in the middle third of the ureter.