Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: A prospective study

146 patients whose ureteral stones did not pass spontaneously participated in a prospective study on optimal management. Patients were offered two tre atment options: extracorporeal shock wave lithotripsy (ESWL) and ureterosco py (URS). The stone was treated with the technique preferred by the patient . In case of treatment failure after first-line therapy, patients again cou ld decide on how to proceed. Stone analysis could be obtained from 72.6% pa tients. ESWL was the primary treatment in 66.4% patients. In 2 patients, ES WL was the secondary treatment after failed URS. URS was the first-line the rapy in 33.6% patients. In 29 patients URS was done after failed ESWL. For analgesia, sedoanalgesia or spinal anesthesia were used. Analgesia was requ ired in 74.2% ESWL and 100% URS sessions. Following ESWL, 70.1% patients be came stone free. In 29.9% ESWL failed. Distal stones had a higher failure r ate than proximal or mid-ureteral calculi. Distal stones treated without su ccess were significantly larger than those treated successfully. Failures w ere switched to URS. Stone analysis could be obtained in 26 patients with f ailed ESWL: 23/26 consisted of pure whewellite or mixed whewellite stones. Clinically relevant complications were not observed. After URS, 94.9% of th e patients became stone free. In distal stones, the stone-free rate was 97. 5%. There was only 1 relevant complication: a proximal ureteral lesion requ iring surgical repair. Our study demonstrates that URS is a safe and highly effective treatment option for ureteral stones. In patients with distal ur eteral stones, it should be offered as a first-line treatment. When whewell ite is expected as the stone mineral, URS is the treatment of choice.