Surgical Management of Ureteral Stone Disease

Although many ureteral stones pass spontaneously, some facilitated by the use of medical expulsive agents, surgical intervention for ureteral calculi remains common. For most ureteral stones, ureteroscopy (URS) and shock wave lithotripsy (SWL) are the primarily treatment modalities; the choice of optimal modality for a particular stone depends on size, composition and location of the stone. While a few randomized trials and systematic reviews have shown that both treatment modalities are acceptable choices for stones in all ureteral locations, ureteroscopy is associated with the highest stone free rates with the fewest procedures, albeit at a cost of a higher, although still low, complication rate. The use of medical expulsive agents has been shown to improve clearance of fragments after SWL. However, the use of stents in association with SWL provides no advantage with regard to stone free rates or need for emergency attention, but does increase lower urinary tract symptoms. Stent placement after URS has also been shown in randomized clinical trials to be unnecessary after routine, uncomplicated.