Extracorporeal Shock Wave Lithotripsy for Mid and Lower Ureteral Stones

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Abstract
Concerns have been expressed by some in the United States that extracorporeal shock wave lithotripsy (SWL) for mid and lower ureteral stones could damage ovarian reproductive function, is difficult to perform with a Dornier HM3, and is not as effective as ureteroscopy. Seventy-nine patients with midureteral stones and 45 patients with lower ureteral stones were treated using Dornier HM3 and Medstone STS lithotripters. With the latter machine, the head and foot angle radiographs, the absence of the water-filled tub, and the easy prone positioning of the patient made the visualization and treatment of the mid and lower ureteral stones easier to perform. With single stones, the stone-free rate at 3 months was 77%, the retreatment rate was 2%, and the post-SWL secondary procedure rate was 15%. However, stone retrieval by ureteroscopy in the lower third of the ureter is a single procedure without the need for secondary or repeat treatments and, with reported stone-free rates of 83% to 93%, it is more efficient and less expensive than ESWL.