Treatment of ureteral stone disease: the role of ESWL and endourology

Summary In recent years, extracorporeal shockwave lithotripsy (ESWL) has proved a safe and easily reproducible method for the treatment of calculi in the upper urinary tract above the iliac crest. Current indications for ESWL as single therapy encompass approximately 60%–70% of all stones. The use of endourological methods as auxiliary procedures can enhance the range of indications to 95% of all renal stones and 85% of all ureteral stones. In the last year, 1340 patients have been successfully treated for urinary calculi at our department. Evaluation of all stone cases shows that ESWL alone, ESWL combined with percutaneous techniques, or percutaneous techniques alone were performed on 93% of all patients. Only 7% of patients had to undergo open surgical treatment, 1% for renal stones and 15% for ureteral stones. Ureteral stones are still among the problem stones for ESWL, in many cases requiring time-consuming combined procedures with either of the percutaneous methods. Furthermore, ureteral obstruction caused by stone particles as a complication after ESWL-treatment of large renal stones has to be relieved using percutaneous techniques. In this report we describe our approach in detail and discuss our results.