Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi: To Stint or Not To Stint?*

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Abstract
A randomized study was undertaken to assess the effectiveness and morbidity of stent placement on patients undergoing extracorporeal shock wave lithotripsy (SWL) with nonobstructing upper ureteral calculi (≤ 1.5 cm). Sixty-two patients were randomized to a stent or no stent (i.e., treatment in situ) protocol prior to SWL treatment on a Dernier HM3 or a Siemens Lithostar. Patients with indwelling ureteral stents placed prior to SWL treatment were subjected to fewer shock waves than those treated in situ on both lithotripters. However, patients with stents experienced increased irritative voiding symptoms and a prolonged convalescence. Stone-free rates, residual fragment size, numbers of auxiliary procedures, emergency room visits, and hospital readmission rates were similar in the two groups regardless of the type of lithotripter used. We conclude that in situ SWL therapy for nonobstructing proximal ureteral stones is effective and safe. In these patients, the placement of ureteral stents is expensive, discomforting, and does not improve the SWL result.