Extracorporeal Shock Wave Lithotripsy for Ureteral Stones: A Retrospective Analysis of 417 Cases

Abstract

We treated 417 patients with upper ureteral stones with extracorporal shock wave lithotripsy. All patients with obstructing stones underwent retrograde manipulation, which was successful in 57 percent. Management of obstructing stones in situ (215 patients) with and without decompression of the collecting system required additional treatments in 13 percent and ancillary procedures in 25 percent. Nonocclusive ureteral stones were not manipulated. Treatment of these stones in situ slightly increased the need for postoperative ancillary procedures, compared to successful respositioning into the kidney (5.9 versus 3 percent). Secondary treatments, however, were necessary as often as with occlusive stones. The main reason for failure of extracorporeal shock wave lithotripsy was the lack of fluid around an impacted stone. An energy absorptive effect of muscle tissue for stones projecting on the psoas muscle could not be demonstrated. The best and most consistent results were obtained when the stone was manipulated successfully into the renal collecting system.