Comparison between ureteroscopy and extracorporeal shock wave lithotripsy in the treatment of distal ureteral stones

Objective: We compared ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of distal ureteral stones. Materials and methods: The study included 159 patients with distal ureteral stones. Of these, 78 patients (36 women, 42 men; mean age 43 years) underwent URS, and 81 patients (43 women, 38 men; mean age 41 years) underwent ESWL. Evaluations were made on the first postoperative day by plain X-ray, and after one month by X-ray, ultrasonography (US) and/or intravenous pyelography in the URS group, and one week after each ESWL session and one month after the final session by X-ray and/or US. The two groups were compared with respect to stone size, success rate, use of a ureteral catheter, and complications. In addition, 52 patients (30 URS, 22 ESWL) were prospectively inquired about patient satisfaction. Results: The mean stone size was 9.4 mm (range 5 to 15 mm) in the URS group, and 8.9 mm (range 5 to 15 mm) in the ESWL group. The two groups were similar with respect to age, sex, stone size, and success rate (p> 0.05). Stone-free rates were 98.7% and 91.4% in the URS and ESWL groups, respectively. The mean URS time was 35.3 min (range 12 to 55 min) and nine patients (11.5%) required ureteral stent placement. No significant complications occurred during URS except for hemorrhage in one patient and four patients (5.1%) had high fever postoperatively. The mean number of ESWL sessions applied was 2.3 (range 1 to 6) and the mean number of shock waves delivered was 4,250 (range 2.500 to 5,000). In the ESWL group, 42 patients (51.9%) had macroscopic hematuria lasting a week, and three patients had persistent pain. One patient required double J stent insertion due to the development of stone street. Rates of patient satisfaction were 93.3% (28/30) and 68.2% (15/22) in the URS and ESWL groups, respectively. Conclusion: Considering the advantages of a higher success rate at only a single session and higher levels of patient satisfaction, URS may be performed as the primary treatment option in the treatment of distal ureteral stones.