Treatment of Ureteral Stones by Extracorporeal Shock Wave Lithotripsy: With Ureteral Catheter or in Situ?

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Abstract
Many authors recommend that stone manipulation or catheter placement be attempted before SWL of ureteral stones. We tried to insert ureteral catheters before SWL on the unmodified Dornier HM3 machine in all patients treated for solitary ureteral stones between April 1986 and December 1991, succeeding in 77.5% (n = 395) of those for whom adequate follow-up is available for analysis. The stone-free rates with SWL alone in the series of 510 patients were 93% in patients with catheters and 75% in patients without catheters. An additional 6% of the patients in both groups became stone free with the aid of ureteroscopy. Eventually, only 0.5% of the patients with a catheter and 1.7% of the patients without a catheter had residual fragments. Among patients with a ureteral catheter after any procedure, 58.7% had no need for pain relief medication and no fever; the figure in the patients treated without a catheter was 74.4%. Although the success rate of SWL for ureteral stones is higher with a ureteral catheter in place, the incidence of complications also is higher. We recommend trying in situ SWL initially for patients with a ureteral stone.