Comparative study of the role of endo-urological manipulation in the treatment of ureteric calculi using extracorporeal shock wave lithotripsy.

The results of treatment of 115 patients with upper and mid-ureteric calculi, using endo-urological manipulation and extracorporeal shock wave lithotripsy were reviewed. The number of shocks administered, the kilovoltage used, the radiation exposure time and the degree of fragmentation achieved were evaluated. Complications occurring in the course of this treatment were also reviewed. A significantly lower number of impulses was required for fragmentation to be apparent at 24 h post-treatment, when the ureteric calculus was able to be manipulated back into the renal pelvis. However, at 6 weeks post-extracorporeal shock wave lithotripsy (ESWL) satisfactory fragmentation was apparent in approximately equal percentages of patients who had undergone successful and unsuccessful manipulation. In addition, a significantly greater mean radiation exposure was used in the treatment of mid-ureteric calculi that could not be successfully manipulated and required treatment in situ within the ureter. These results suggest that treatment of a ureteric calculus in situ within the ureter provides a satisfactory method of fragmentation, although fragmentation takes longer to become apparent than when treatment is undertaken upon a calculus within the renal pelvis. The greater radiation exposure for patients in whom ureteric calculi were treated in in situ within the ureter may reflect the operators' attempts to visualize a change in configuration of the calculus similar to that seen when treatment is given to a stone that has been successfully manipulated. However, since the absence of fragmentation at 24 h post-surgery does not indicate a failed treatment in this group, prolonged screening of the calculus with fluoroscopy may be unnecessary. The complication rate of this method of treatment was low.