Management of 10-15-mm Proximal Ureteral Stones: Ureteroscopy or Extracorporeal Shockwave Lithotripsy?

Objectives: To provide appropriate evidence for treatment planning of patients with an upper ureteral stone, 10 to 15 mm in size, by analyzing the therapeutic outcomes for those undergoing semirigid ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy (URSL) and shockwave lithotripsy (SWL) prospectively. Methods: During the study period, 197 patients with a 10 to 15-mm proximal ureteral stone were included. The data of 166 patients were analyzed. Both URSL and SWL were offered and explained to the patients and the procedure was chosen on the basis of the patients' preference. URSL was conducted using a 7F to 8.9F semirigid ureteroscope and holmium:yttrium-aluminum-garnet laser with its 200-μm quartz fiber was used for lithotripsy. The endpoint of the study was freedom from stone on 3-month imaging studies. The patient demographics, stone-free rate, operation time, complications, and the need for any ancillary procedure were analyzed prospectively in the two groups. Results: Of the 166 patients, 40 (24%) chose URSL and 126 (76%) chose SWL. After 3 months of follow-up, the stone-free rate after URSL (29 [72.5%] of 40 patients) and SWL (99 [78.6%] of 126) groups, were statistically equal (P = 0.42). Also, the mean operative time, need for application of salvage procedures, and postprocedural complication rates were comparable between the two groups. Conclusions: We have shown that SWL has enough capacity for the management of proximal ureteral stones 10 to 15 mm in size. Although ureteroscopy tends to make patients stone free faster, because of the minimally invasive nature of SWL, patients still favored it over ureteroscopy.