MANAGEMENT OF URETERAL STONES

Based on experience with over 2,000 patients, the treatment of ureteri c stones today relies on extracorporeal shock wave lithotripsy (ESWL) in situ and ureteroscopy with semirigid, ultrathin ureteroscopes combi ned with pneumatic or laser lithotripsy. All stones in the upper and l arger stones in the distal third of the ureter are preferably treated by ESWL in situ, whereas smaller stones in the distal ureter are bette r treated by endoscopy. Midureteric stones continue to be the domain o f primary ureteroscopy; in cases of moderate obstruction in asymptomat ic patients, it may also be acceptable to wait for the stone to pass i nto the distal ureter spontaneously to be treated by ESWL in situ ther e. Manipulation of the stone back into the kidney and treating it by E SWL there (push back/ESWL) offers no advantage over ESWL in situ, as r esults are not better yet morbidity is higher. 'Blind' instrumentation has lost all justification, and incisional ureteric lithotomy is no l onger indicated but in exceptional cases.