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Year : 2003  |  Volume : 20  |  Issue : 1  |  Page : 23-27

Management of proximal ureteral stones - comparison of outpatient ureterolithotripsy with in-situ shock wave lithotripsy (SWL)

Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Correspondence Address:
P B Singh
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005
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Source of Support: None, Conflict of Interest: None

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Objectives: The aim of this study is to review the feasi­bility and effectiveness of ureteroscopy with intracorporeal lithotripsy under intravenous sedation on outpatient basis as a primary procedure in patients with proximal ureteral calculi and its comparison with in situ SWL. Methods: From January 2000 to December 2001, 56 patients with proximal ureteral calculi underwent uretero­lithotripsy and 32 patients underwent in situ shock wave lithotripsy (SWL). Ureterolithotripsy was performed with 8.0 Fr Wolf rigid ureteroscope and Swiss Lithoclast on daycare basis. Results: In patients managed with ureterolithotripsy, stone was successfully reached and fragmented in 47(83.93%) patients. Complete stone fragmentation and spontaneous passage occurred in 40 (71.4%)patients with single session. Seven (12.5%) patients required more than one session for complete clearance. JJ stent was required in 13(23.2%) patients. One case of ureteral perforation was managed successfully with JJ stent. In SWL group, 28 (87.5%) patients became stone free at 3 months. Seven­teen patients (53.2%) required retreatment and adjuvant procedure was done in 6 patients (18.7%). Conclusions: Ureterolithotripsy and in situ SWL are equally effective for proximal ureteral stone. Ureterolitho­tripsy for proximal ureteral calculi has high success rate with low morbidity. It can be done safely with intravenous sedation and local anesthesia. Ureteroscopic stone re­moval can be considered as primary approach in patients with proximal ureteral calculi reserving SWL for those who can afford it.

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