Dornier extracorporeal shock-wave lithotripsy for ureteral stones

Most investigators think that ESWL is the preferred method for treating calculi in the upper ureter--that segment proximal to the superior margin of the iliac crest. Ureteroscopic manipulation, percutaneous antegrade manipulation, and open ureterolithotomy are secondary choices. The treatment of calculi in the lower ureter--that segment between the upper border of the iliac crest and the ureterovesical junction--is somewhat controversial. Most urologists favor ureteroscopic manipulation: small stones can be extracted, while larger stones can be fragmented with ultrasonic, electrohydraulic, or even laser lithotripsy. However, manipulation in the presacral ureter is more difficult than in the juxtavesicular ureter, and all stones are not amenable to ureteroscopic management. Our experience at the University of Virginia led us to use ESWL for lower ureteral stones when ureteroscopic manipulation fails or cannot safely be accomplished or when patients refuse cystoscopy. Juxtavesicular stones are treated with a minor modification (sitting position) of standard supine ESWL, whereas presacral stones are treated with prone ESWL.