2ND IN-SITU EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN NOT DISINTEGRATED URETERAL STONES IS PREFERRED TO RETROGRADE MANIPULATION

In this study we tried to determine the optimal treatment of upper ure teral stones which are not disintegrated by the first extracorporeal s hock wave lithotripsy (ESWL) and to analyze the cost-benefit ratio of retrograde manipulation into the renal pelvis. 180 patients with an up per ureteral stone were treated by ESWL in situ. 40 patients needed a retreatment and were randomized for retrograde manipulation before ESW L or ESWL in situ without a prior manipulation. In both the in situ gr oup and in the push-and-smash group, the stone-free rate was 75%. In s tones <8 mm, the disintegration rate was higher after retrograde manip ulation into the renal pelvis and inserting a DJ catheter. In conclusi on, ESWL in situ is the optimal treatment for all patients with upper ureteral stones. We reserve retrograde manipulation before a second ES WL for stones <8 mm. Routinely employed auxiliary procedures such as p lacement of a DJ catheter increase the costs significantly, without im proving the results.