Extracorporeal shockwave lithotripsy compared with ureteroscopy for the removal of small distal ureteral stones

INTRODUCTION: The treatment of small distal ureteral stones smaller or equal to 5 mm in size is still highly controversial. In distal ureteral stones larger than 5 mm in size, ureteroscopy (URS) has been shown in many studies to be superior to shockwave lithotripsy (SWL). The objective was to analyze the stone-free rate after treatment of distal ureteral stones with in situ SWL or URS. MATERIALS AND METHODS: A total of 3,857 SWL treatments were performed at our institution between 1996 and 2001. During this period 45 in situ SWL procedures were performed with the Dornier MFL 5000 lithotripter on distal ureteral stones regardless of the stone size. A total of 262 URS treatments were performed on distal ureteral stones. URS for small (5 mm or less) distal ureteral stones was performed in 110 cases. RESULTS: Distal ureteral stones smaller or equal to 5 mm in size were treated successfully stone free in 78% in one SWL session. Patients required a second SWL in 14% of the cases and 8% of the patients required a third SWL session. URS patients were successfully stone free after the procedure in 97% of the cases. Failed URS that needed an additional URS were performed in 2 and 1% of the patients had one SWL in situ treatment. CONCLUSIONS: URS treatment has shown to be the therapy of choice for distal ureteral stones. It is more effective than SWL treatment in this stone location. In experienced hands URS is a safe though even more invasive procedure than SWL. This can be expected as urologists perform more than 40 URS procedures per year.