An innovative approach to management of lower third ureteral calculi.

A total of 130 patients with symptomatic lower third ureteral calculi underwent 136 treatments by 43 accredited urologists. These treatments were performed at a fixed lithotripsy site and 16 mobile sites using the Medstone lithotriptor from December 1990 through January 1992. The average stone size was 8.16 x 5.14 mm. A total of 126 patients underwent a single treatment and 4 underwent multiple treatment sessions. Of the 126 patients undergoing monotherapy 10 (8%) were lost to followup, while 101 of the remaining 116 evaluable patients (87%) were stone-free with a single treatment. The 15 patients in this subgroup who were considered failures and the 4 patients who underwent multiple treatments had overall larger stone sizes. The preoperative stent placement rate was only 32%. The treatments were well tolerated by the patients. Our report confirms a high efficacy rate with the second generation bathless lithotriptor for management of lower third ureteral calculi. The importance of a stable and qualified technical team cannot be overemphasized.