Ureteroscopic pneumatic versus extracorporeal shock wave lithotripsy for lower ureteral stones.

OBJECTIVE To compare the efficacy of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of lower ureteric stones in terms of stone-free rates. STUDY DESIGN Randomized trial. PLACE AND DURATION OF STUDY Department of Urology, Government Institute of Kidney Diseases and Transplant, Hayatabad, Peshawar, from September 2010 to March 2011. METHODOLOGY Patients (n=136) presented with lower ureteric stones and fulfilling the inclusion criteria for the study were included. They were divided equally into two groups. Division of patients was done by lottery method. Patients in group A were treated with ureteroscopic pneumatic lithotripsy (URS) as compared to those in group B, who were dealt with extracorporeal shock wave lithotripsy (ESWL). RESULTS There were 46 males (67.6%) and 22 females (32.3%) with a ratio of 2.1:1 in group A as compared to 50 males (72%) and 18 females (26.4%) with a ratio of 2.8:1 in group B. Mean age was 35.2 ± 9.5 years in group A and 35.4 ± 9.2 years in group B. The mean stone size in group A was 12.8 ± 3.7 (range 5 - 25 mm) and 12.82 ± 3.5 (range 5 - 25 mm) in group B. Mean hospital stay in group A was 2.07 ± 0.6, while patients in group B were all day-cases. The statistical difference was significant in terms of repeat procedure, auxiliary procedure postoperative analgesia and stone free status at 3 months (p=0.043, 0.020, 0.000, 0.001) respectively, while it was not significant in respect of complications of procedure (p=0.753). CONCLUSION URS proved more effective than ESWL for the treatment of ureteric calculi. However, ESWL performed as an outpatient procedure showed fewer complications.