Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy? Results of a multicenter study

Purpose: In a randomized study, we analyzed the treatment results of ureter orenoscopy (URS) and shockwave lithotripsy (SWL) for extended-mid and dista l ureteral stones. We investigated also, for reasons of cost effectiveness, the factors influencing the outcome, the complications, and the need for a uxiliary procedures. Patients and Methods: In three regional hospitals, we selected 156 patients with extended-mid and distal ureteral stones. After randomization, 87 were treated with URS, and 69 with SWL, The treatment results were studed in re lation to complications, the need for auxiliary procedures and stone factor s, urinary tract infection (UTI), dilatation, and kidney function. Results: After retreatment of 45% of the patients, the stone-free rate afte r 12 weeks in the SWL group was 51%, After a retreatment rate of 9% of the patients in the URS group, the stone-free rate was 91%, Including the numbe r of auxiliary procedures, we calculated the Efficiency Quotient (EQ) as 0. 50 for SWL and 0.38 for URS. After correction and redefinition of auxiliary procedures, the EQ was 0,66, The mean treatment time for SWL was 52 minute s and for URS 39 minutes. General anesthesia was more frequently needed in URS patients. Complications occurred more often in the URS group (22 v 3 an d 24 v 13, respectively). These were mostly mild, and all could be treated with a double-J stent, antibiotics, or analgetics. A lower stone-free rate was achieved in patients with larger (greater than or equal to 11 mm) stone s (75% v 85% for smaller stones in the URS group and 17% v 73% in the SWL g roup. In the URS group, the stone-free rate of patients with extended-mid u reteral stones was lower than that of patients with distal ureteral stones. Calculating the costs for URS and SWL appeared impossible because of the d ifferences in available equipment. Conclusion: The stone-free rate after URS is much higher than after SWL, an d the EQ in our series was strongly dependent on definitions. The decision about how to treat a patient with an extended-mid or distal ureteral stone therefore should not be made primarily on the basis of cost effectiveness b ut rather on the basis of the availability of proper equipment, the experie nce of the urologist, and the preference of the patient.