Abstract

Objective: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL), semirigid and flexible ureteroscopy (URS) in patients with proximal ureteral calculi.

Materials and methods: The study included 165 patients (103 males, 62 females; mean age 43±10 years; range 18 to 62 years) who were treated for a single radiopaque proximal ureteral stone in three clinics. Treatment modalities included ESWL (n=83, 50.3%), semirigid URS (n=54, 32.7%), and flexible URS (n=28, 17%). The results obtained from each of the three approaches were compared.

Results: While 77 patients (92.8%) in the ESWL group were stone-free after three sessions, 41 patients (75.9%) and 27 patients (96.4%) were stone-free after a single-step procedure in semirigid and flexible groups, respectively. Reasons for failure in the ESWL group were impacted stone in four patients and steinstrasse formation in two patients. These patients were eventually managed by endoscopy. Of 13 failures (24.1%) in the semirigid group, the most frequent cause was stone migration into the kidney (n=9, 16.7%), followed by macroscopic hematuria (n=2, 3.7%), inability to reach the stone (n=1, 1.9%), and ureteral avulsion (n=1, 1.9%). These patients were further managed by ESWL (n=10), flexible URS (n=2), or open surgery (n=1). In the flexible group, the stones migrated into the kidney in three cases (10.7%), but they were immediately removed during the operation. The only failure (3.6%) in this group was associated with bleeding originating from mucosal injury, which was further treated with ESWL. No procedure-related ureteral strictures occurred during the follow-up.

Conclusion: Even though ESWL is a successful treatment modality in the management of proximal ureteral calculi, flexible URS may be an effective and safe alternative in patients demanding an efficient and quick stone relief in a single session.