[Extracorporeal lithotripsy or ureteroscopy for the treatment of calculi of the lower ureter].

Two therapies, ureterolithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) can be used in the treatment of lower ureteral calculi. In a retrospective analysis ureterolithotripsy and extracorporeal shock wave lithotripsy for lower ureteral calculi were compared to evaluate morbidity. During a 3 year period 161 patients treated with ureterolithotripsy and 71 who underwent extracorporeal shock wave lithotripsy (Siemens Lithostar) were analysed as to the success rate, effectiveness quotient, complication rate and length of hospitalization. Followup consisted of ultrasound and a plain film of the kidneys, ureteres and bladder 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 95.5% of the patients treated endourologically with a 1.2% retreatment rate. In the group treated with extracorporeal shock wave lithotripsy success rate was 82.1% with a 19.6% retreatment rate. Among the patients who underwent ureteroscopy and stone removal 16.1% had complications compared to 10.7% in the ESWL group. The mean stone diameter was 0.8 cm in the endourological group and 0.7 cm in the ESWL group. Stone size was not a determining factor for the stone free rate and effectiveness quotient in the patients treated endourologically. Indeed, in patients who underwent ESWL for large stones the stone-free rate and effectiveness quotient decreased to 78.9% and 57.7%. Ureterolithotripsy will continue to have a primary role in the management of lower ureteral stones. As extracorporeal shock wave lithotripsy is an effective noninvasive procedure, requiring no anesthesia and hospitalization as routine, it may be considered an alternative either primarily or after failed ureteroscopy.