In Situ Extracorporeal Shock Wave Lithotripsy in the Management of Ureteric Calculi

Abstract

It was to determine the efficacy of ESWL in ureteric calculi, with reference to site, size and radiodensity of the stone. Prospective study of patients undergoing in situ ESWL of ureteric calculi with lithostar plus by Seimens. Consecutive 35 patients with ureteric calculi of 7mm size to 15mm size and irrespective of site were included in the study. Pre ESWL evaluation done routinely in which patients had IVU when required to observe the site of stone and level of ureteric obstruction. We looked at success of ESWL for stones at various location in the ureter, along with number of session, also of analgesia and need of any ancillary procedure. There were 29 (83%) male and 6 (17%) female patients. 34% presented with upper ureteric stones, 17% with middle ureteric and 49% with lower ureteric stones. In upper and middle ureter size range was 13-15mm. lower ureter had larger sizes of stones. 48.57% patients had only one session for stone clearance while 37.50% had to go for second session for stone clearance. Whereas 11.4% patients had to go for three or more session and 5.7% patients had their stones not cleaned so the needed some other procedure for stone clearance. In our setup where too much expertise and instrumental facilities for ureteroscopy are not ideal, ESWL is a favourable choice for ureteric stones. Most patients preferred anaesthesia free, out patients based treatment provided that is available, effective and without comorbidity. The enthusiasm for ureteroscopy should not be the main determinant for selection of a treatment modality.