Efficacy of Shock Wave Lithotripsy in Lower Ureteric Calculus

Introduction: Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) are effective treatments in the management of ureteric calculus. ESWL is noninvasive, associated with less morbidity than URS. Moreover, URS requires specialized training, requires more anesthesia, and more often requires ureteral stent placement. We have analyzed the efficacy of ESWL in the management of lower ureteric calculus. Materials and Methods: Study conducted in the patients attended in the urology clinic for the management of lower ureteric calculus. Forty-eight patients were included in the study. Informed consent obtained from all the patients after explaining all available modalities of treatments and they are divided into two groups based on stone size, Group 1: ≤10 mm and Group 2: >10 mm. These patients were again divided based on computed tomography-hounsfield unit (CT-HU) into Groups A and B, Group A: ≤1000 Group B: >1000 HU. All the patients underwent ESWL in donier compact delta II (electromagnetic generator) machine as outpatient procedure. Study data analyzed using SPSS (V: 17) software. Results: Results of 48 patients analyzed. Stone-free rate in ≤10 mm group was 22/25 patients (88%) and in >10 mm group was 13/23 patients (56.5%) P < 0.01. When CT-HU increases success rate decreases, when HU was ≤1000 (Group 1A and Group 2A) 34 patients (85%) successfully cleared their stones, failure occurred only in 6 patients (15%). When HU > 1000 (Group 1B and Group 2B) only one patient cleared the stone (12.5%), failed in 7 patients (87.5%), this difference was statistically significant (P < 0.001). Conclusion: In situ ESWL for lower ureteric calculus is an effective, non-invasive, and a viable treatment option with no major complications. Patients with lower ureteric calculus size ≤10 mm and CT-HU ≤ 1000 had high expulsion rate with ESWL. Other modalities of treatment may be needed in patients with stone size >10 mm and CT-HU > 1000.