Semirigid Ureteroscopic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteric Stones: A Comparative Appraisal of Efficacy and Safety

Abstract Background: Urolithiasis is a common disease worldwide; many options are now available for its management, but evaluation of patient- and stone-related factors helps to select the treatment modality. Aim of Study: The objective of the study was to compare the efficiency and integrity of semi-rigid ureteroscopy (URS) versus extracorporeal shock wave lithotripsy (ESWL) regarding stone-free rate and potential complications for patients with upper ureteric stone. Patients and Methods: A prospective study was performed, comprising 100 patients with upper ureteric stone sized < 10 mm. They were assigned into two equal groups: one group underwent ureteroscopic pneumatic lithotripsy and the other group underwent ESWL sessions. Patients’ follow-up done at 1 month and 3 months for stone clearance and eventual complications, many factors related to the patient and stone were evaluated. Results: The mean age of all patients was 42.54 ± 14.07 years; 69% of patients were males. The initial stone-free rate (SFR) was statistically significant between the two groups (80% for URS and 62% for ESWL), SFR for ESWL group increased to 76% and 82% after the 2 nd and 3 rd sessions, respectively; however, it remained higher in the URS group after 3 months of treatment. Complications were minor in the two groups. Analysis of stone- and patient-related factors revealed no significant impact of patient’s age, gender, height, and body mass index in both groups, whereas stone size, stone density, and ureteral wall thickness had a significant effect on SFR, the significance of proximal ureteric diameter (PUD) and renal pelvis anterior–posterior diameter was noticed in ESWL group only. Conclusion: Both ESWL and URS were safe and effective means for treating upper ureteric stones smaller than 10 mm, but evaluation of several factors related to patient and stone may help improve stone outcome.