Primary in situ extracorporeal shock wave lithotripsy in the management ofureteric calculi: results with a third-generation lithotripter

Objective To review the results of primary in situ extracorporeal shock wav e lithotripsy (ESWL) for the treatment of ureteric stones using a third-gen eration lithotripter, the Dornier MF, 5000 (Dornier Medizentechnic, Germany ). Patients and methods The study comprised a retrospective review of treatmen t outcome in 180 patients with 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and establishing reasons for failure. Results At the 3-month follow-up, 88% of patients were stone-free; 21 patie nts failed ESWL and were treated by ureteroscopic stone extraction with no complications. Stone-free rates were 90% for upper ureteric, 89% for middle -third and 86% for lower-third calculi, Twenty-one patients required auxili ary procedures in the form of JJ stenting or nephrostomy. Failure of ESWL w as associated with stone size (>1.3 cm) hut not location or inadequate trea tment. Conclusion Where prompt access to ESWL is available, primary in situ ESWL r emains an effective form of treatment for all ureteric calculi, although st one-free rates are lower for larger stones.