Management of ureteral calculi: a comparison of shock-wave lithotripsy and ureteroscopy

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Abstract
In-situ extracorporeal shock-wave lithotripsy is currently accepted as the optimal treatment for non-impacted upper ureteric stones less than 1.5 cm in size. However, the management of lower ureteric stones remains controversial. The latest generation of lithotriptors has made it possible to localize and treat nearly all ureteric stones under sedation analgesia as an outpatient procedure with acceptable success rates. However, up to 25% of all ureteric stones may require ureteroscopic retrieval for various reasons. With miniaturization of ureteroscopes, and newer intracorporeal lithotripsy, it has become safe and possible to remove most ureteric stones under sedation analgesia as a day-case procedure with high success rates and minimal morbidity. Ureteroscopy has been shown to be safe and effective in pregnant women and in children. It is necessary to consider multiple factors when deciding on the most appropriate therapy. Stone-free rate, auxiliary procedure rate, attendant morbidity, need for anaesthesia and hospitalization, number of follow-up visits and convalescence period, as well as overall cost of the treatment, will guide the physician and patient in choosing a treatment modality.

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