Minimally invasive treatment of ureteric calculi using modern techniques.

Between July 1985 and July 1986, 226 upper and 62 distal ureteric calculi were treated. In situ extracorporeal shockwave lithotripsy (ESWL) is the treatment of choice for upper and distal ureteric calculi, with success rates of 81 and 76% respectively. Retrograde manipulation of the calculus was undertaken only when in situ ESWL was impossible because of difficulty in localisation. Although ESWL after successful mobilisation was successful in 95% of patients, retrograde mobilisation was possible in only 80%. Antegrade ureterorenoscopy via a percutaneous nephrostomy was performed to avoid open surgery if retrograde mobilisation was not feasible, and was successful in 90%. Two second generation lithotripters, the modified Dornier HM3+ and the Wolf Piezolith 2200, both suitable for treatment without anaesthesia, were compared in terms of efficacy. In situ ESWL of upper ureteric calculi was successful in 70.6% with the HM3+ and 37.2% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2200 because of inadequate ultrasound localisation. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. We report our experience of ESWL using the prone position for iliac ureteric calculi; 8 of 10 patients were treated successfully in situ.