TREATMENT OF MID AND LOWER URETERAL CALCULI - EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY VS LASER URETEROSCOPY - A COMPARISON OF COSTS, MORBIDITY AND EFFECTIVENESS

Objectives To determine the efficacy and costs of extracorporeal shock -wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treat ment of mid-and lower ureteric calculi, Patients and methods The recor ds of patients treated primarily by ESWL and URS were analysed retrosp ectively. Treatment with ESWL included 63 patients (42 men and 21 wome n, mean age 52 years, range 23-78, 19 mid- and 44 lower ureteric calcu li), All patients received 4000 shock waves at a mean energy setting o f 18.1 kV, URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope, Stones were fragmented with a pulsed-dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 mu m fibre. All ureteroscopies were performed with the pa tient under general (n = 17) or spinal (n = 87) anaesthesia in a mean treatment duration of 34 min, Stones were located in the mid-ureter in 24 patients and in the lower ureter in 80. The outcome was assessed b y stone-free rates, re-treatment rates, time to become stone-free, com plications and costs. Results ESWL for mid-and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone-fr ee within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of <50 mm( 2). The costs of URS were higher than those for ESWL. Conclusions ESWL provides a noninvasive, simple and safe option for the management of mid-and lower ureteric calculi, provided that the stones are <50 mm(2) ; larger stones are best treated by URS.