Comparative study of extracorporeal shock wave lithotripsy and ureteroscopy in the management of upper third ureteral calculi

Purpose
To do a matched pair analysis of extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopy (URS) for the management of upper third ureteral calculi.
Patients and methods
Totally 60 cases, between 25 and 52 years referred to our endourology clinic with large upper third ureteral calculi (≥1 cm in size and ≥900 HU in density). The cases were classified into two groups. Group A (30 cases) underwent ESWL, while group B (30 cases) underwent URS. All cases were evaluated by plain KUB (Plain X-ray on Kidney, Ureter and Urinary Bladder), abdominal ultrasound, and MSCT KUB (MultiSlice Computed Tomography on Kidney, Ureter and urinary Bladder) without contrast. Stone clearance has been assessed both after the procedure and at 3-month follow-up for URS cases and 3-week follow-up for ESWL cases.
Results
Complete stone clearance occurred in 20 (66.7%) of the 30 patients undergoing ESWL and in 24 (80%) of the 30 patients undergoing URS, indicating no significant difference in overall stone clearance between both groups. However, the ESWL cases needed longer time, greater number of sessions, and sometimes auxillary procedures and acorrdingly ESWL was less cost-effective than URS. We also identified in our study three cutoff points for ESWL cases above which the case will mostly need more than one session (skin to stone distance >8.8 cm, stone size >1.1 cm, and stone density >1100 HU).
Conclusion
Both ESWL and URS are efficient modalities for the management of upper third ureteral stones. However, in large upper third ureteral stones (>1.1 cm), with high density (>1100 HU) especially in obese patients (skin to stone distance more than 8.8 cm), URS has proved to be a more practical option.