Eswl for Ureteral Calculi

Abstract

The role of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi is still being debated. We evaluated our results in a large series to clarify the role of this modality.

Patients and methods

Between September 1997 and December 2004, 657 patients (414 males, 243 females) with ureteral calculi were treated with extracorporeal shock-wave lithotripsy (ESWL) in situ with 2 types of lithotripters (Wolf Piezolith-3000 e Storz Modulith SLX) that offers simultaneously X-ray and ultrasound for stone localization. 971 interventions were performed, with an average of 1.47 sessions/patients. Stone size ranged from a minimum of 5 to 20 mm. Only in one case neuroleptoanalgesia was performed. Targeting was done both by ultrasound and radioscopically.

Results

449 (68.3%) patients were stone-free after a single ESWL session, whereas, for the rest, more than one session was required. Auxiliary measures (double J ureteral stent, nephrostomy) were necessary for 32 (4.8%) patients. In 3 cases, infectious complicantions occurred in patients who had not received any antibiotics prophylaxis. Ureterolithotripsy was performed to resolve the case in 9 patients and in 2 was needed to do ureterolithotomy. A 68.3% success rate was achieved with a single ESWL session, it rose to 94% if we considered patients who required max. 3 treatments.

Conclusions

The results prove that the success rate in ureteral calculi is very high if the indications for ESWL are correctly made. Considering that ESWL is performed under no anaesthesia, with short hospitalization (ambulatory care), and with no endoscopic manouvres, it is concluded that extracorporeal lithotripsy is a cost-effective and efficient method to treat and resolve ureteral calculi.