Comparison of the efficacy of extracorporeal shock wave lithotripsy, pneumatic lithotripsy, and laser lithotripsy in the treatment of proximal ureteral calculi

Aims: This study aimed to compare the efficacy of extracorporeal shock wave lithotripsy (ESWL), pneumatic lithotripsy, and laser lithotripsy in the treatment of proximal ureteral calculi, focusing on stone-free rates, complication profiles, and the need for additional interventions. Methods: A retrospective analysis was conducted on 150 patients with proximal ureteral calculi treated with ESWL, pneumatic lithotripsy, or laser lithotripsy. Patients were divided into three equal groups (50 per treatment arm). Demographic and clinical characteristics, procedural outcomes, and complication rates were evaluated. Stone-free status was assessed on postoperative day 1 via direct urinary system radiography and at 1 month using intravenous urography. Results: For stones smaller than 10 mm, the stone-free rates were 93% in the ESWL group, 80% for pneumatic lithotripsy, and 84% for laser lithotripsy. In stones ?10 mm, the rates dropped to 55.0%, 52.6%, and 75%, respectively. There were no statistically significant differences in the distributions of stone-free status, minimal residue, or the requirement for post-procedure URS across procedure types. A higher frequency of pusback was observed in the pneumatic lithotripsy group compared to the other groups (Pneumatic lithotripsy: 31.6% vs. Laser lithotripsy: 12.5% vs. ESWL: 0%, p = 0.012). However, for stones smaller than 10 mm, this difference was not statistically significant. The mean operative duration was longest for laser lithotripsy compared to pneumatic lithotripsy and ESWL (Pneumatic lithotripsy: 36.6 ± 5.2 vs. Laser lithotripsy: 62.8 ± 11.1 vs. ESWL: 28.2 ± 6.4 minutes, p = 0.001). Complication rates were comparable across groups. Conclusion: In smaller ureteral calculi, the three modalities exhibit comparable efficacy. For large ureteral stones, laser lithotripsy achieves better stone-free rates and requires fewer repeat interventions but has a longer operative time. Treatment decisions should be individualized according to stone size, patient factors, and available resources.