What is the optimal treatment for lower ureteral stones larger than 1 cm?

Purpose: To compare the treatment options for lower ureteral stones larger than 1 cm. Methods: The records of 449 patients with lower ureteral calculi larger tha n 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were tr eated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7 %) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureteroli thotomy (group 3). Eighty-seven (19.5%) patients underwent any of the two t reatment modalities because of unsuccessful primary treatment. Results: The overall stone-free rates were 32.4, 90.9 and 95.3% for ESWL, P L and ureterolithotomy, respectively. These values were 84.4% for primary P L and 96.7% for primary ureterolithotomy. The re-treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups. Conclusions: Pneumatic lithotripsy with ureteroscopy seems to be an appropr iate treatment for larger ureteral stones. While ESWL can be tried as a fir st treatment option because of its non-invasive nature, lower success and h igher re-treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.