EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN-SITU OR AFTER PUSH-UP FOR UPPER URETERAL CALCULI - A PROSPECTIVE RANDOMIZED TRIAL

A total of 110 patients with upper ureteral calculi was admitted to a prospective trial and randomly allocated to 2 groups: 1 group treated with in situ extracorporeal shock wave lithotripsy (ESWL) and 1 group treated with ureteral manipulation before ESWL. All patients had solit ary upper ureteral calculi without urinary infection. The stones had t o be smaller than 1 cm. and located more than 2 cm. lateral to the spi ne. ESWL was performed with the Dornier HM3 lithotriptor. One patient in the in situ ESWL group had to be treated twice because disintegrati on of the stone was insufficient after the initial treatment session. All other patients underwent only 1 treatment session. Because 16 pati ents were lost to followup, 94 were evaluable for the analysis of imme diate and long-term results. For disintegration of the stones in situ ESWL needed significantly more shock waves (1,844 +/- 639 versus 1,297 +/- 473, p <0.001) and a higher voltage (19.5 +/- 1.4 versus 18.7 +/- 0.9 kv., p <0.001). There were no severe complications in either trea tment group. At 3 months 44 of 46 patients (96%) after in situ ESWL an d 45 of 48 (94%) after ureteral manipulation before ESWL were free of stones. In view of these results it is suggested that uncomplicated up per ureteral calculi (as defined previously) should be treated first w ith in situ ESWL, thus, avoiding an invasive procedure.