Abstract:
There are two main options for the intervention which are usually used for the treatment of calculi in the upper ureters and these are: extra corporeal shock wave lithotripsy (ESWL) and the lithotripsy by ureteroscope.
Till now, there is controversy regarding which method is the most optimum in the treatment of calculi in the upper ureters.
In this study we try to compare both modalities of treatment and which option consider the first-line treatment for upper ureteric calculi regarding effectiveness (rate of stone free) ,Complications and necessity for additional methods.
From Jan. 2013 to Jan. 2014, one handered patients (54 males and 46 females) with single, unilateral upper ureteric stone size from (6-18 mm) treated in Alhilla teaching hospital are included in this randomized prospective study.
Electromagnetic lithotripter device (Storz Medical, Switzerland) was used for ESWL while we used rigid ureteroscope for lithotripsy.
The choice certain method for treatment was based on the clinical state of the patients and patients’ choice.
Fifty (31 males and 19 females) patients are treated by ESWL, while the other fifty (23 males and 27 females) patients treated by ureteroscopy.
Patients of the two groups were compared regarding overall rate of stone free, the need for additional procedures and rate of complications.
Data analyzed by meta-analysis and p-value>0.05 consider significant and p-value>0.001 consider highly significant.
Patients treated with ESWL achieved a 80% overall SFR with a 30 % auxiliary procedure rate these include (re treatment with ESWL, double-J stent or use of ureteroscopic lithotripsy). While Complications occur in 8% of cases who are treated by ESWL include (pyelonephritis, refractory pain or refractory hematuria).
Regarding group of patients treated with URS had a 92% SFR with an additional procedure rate of 28%which include (double-J stent and ESWL for migrating ureteric stone to the kidney). While Complications occur in 18% of patients treated with ureteroscopy include (complications of anesthesia, urinary tract infections or hematuria).
For ESWL group, the need of auxiliary procedures and complication rate are more common where stone size <1cm.
Where as in ureteroscope group, the need of auxiliary procedures (treatment with ESWL for migrating ureteric stone to the kidney) are higher for those with stone size>1cm. but the complication rate is still higher in patients with stone size <1cm.
So in the urological centers in which both modalities of treatment are present, ESWL is the preferable option for treatment of patients with single upper stone in the upper ureterof ?1 cm while ureteroscopy used for patients had stones of >1 cm.