Comparative Study Between Extra Corporeal Shock Waves Lithotripsy and Ureteroscopic Stone Extraction in Management of Upper and Middle Ureteric Stones

Abstract

SUMMARY T he increased prevalence of small urinary calculi has brought about a change in clinical symptoms, with frequent episodes of renal-ureteral colic, persistent pain and hydronephrosis. In our study we do comparison between extracorporeal shock wave lithotripsy and ureteroscopy in management of upper and mid ureteric calculi. ESWL offers the least invasive method of managing ureteric stones, especially as it is now generally accepted that ureteric stones should be treated in situ. Although less invasive, other factors must be considered when applying this technique; it may require some time before the patient is stone-free, making frequent out-patient assessments and/or re-treatments. URS have optimized ureteric stone fragmentation and removal with decreased morbidity. Therefore, the option of ureteroscopic stone removal, although most patients require anesthesia, has become attractive. In Ain shams university hospitals.from January 2016 to June 2016, a total of 20 patients (15 males and 5 females) with a solitary upper or mid ureteral stone were divided into two groups 10 patients each enrolled in our prospective study. The local ethics committee approved the study protocol. Patients of the first group were treated with ESWL while patients of the second group were treated with URS. The Overall success rate was found to be 90% in ESWL group patients versus 80% in URS patients, the stone free rate in upper ureteral stones cases by ESWL was (100%) and by URS was (80%), and the stone free rate in mid ureteral stones cases by ESWL was (80%) and by URS was (80%). At the end of the study we concluded that ureteral stones 1cm or less in size can be treated safely and effectively by ESWL with a stone free rates more than pneumatic ureteroscopic lithotripsy, while in mid ureteral stones 1 cm or less in size can be treated safely and effectively by ESWL with a stone free rates equal to pneumatic ureteroscopic lithotripsy. Most of the complications are minor and can be treated either conservatively or endourologically without further morbidity or mortality. ESWL and URS lithotripsy failures can be salvaged by further endourological procedures.