Abstract
The treatment of choice for stones in the lower third of the ureter is still to be demonstrated. Extracorporeal shock wave lithotripsy (SWL) in situ (IS) and with a loop catheter (LC) around the stone are both recommended. We randomized 44 patients with such stones into those two treatment groups. Each group consisted of 22 patients. After 2 weeks, 8 (36%), and after 3 months, 9 patients (41%), were stone free in the IS group. Impaction resulting in hydronephrosis at the site of treatment was associated with a low likelihood of success in this group. In the LC group, all 16 men needed epidural anesthesia during treatment. The LC positioning failed in 9 of the 22 patients. Five of the nine (56%) were stone free after 2 weeks. In the other 13 patients, the LC was successfully positioned, and 9 (69%) were stone free after 2 weeks. The rate of absence of stones was almost twice as high after LC treatment as after IS treatment. Although epidural anesthesia was mandatory in men and LC positioning did not succeed in 41% of the cases, we believe that LC use is justified, especially in cases of impaction proved by hydronephrosis. If dilatation is absent, SWL in situ can be performed. If disintegration or evacuation fails and hydronephrosis persists 2 weeks after treatment, ureterorenoscopy can be performed.
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