Comparison of the Efficacy of ESWL and Ureteroscopy in the Treatment of Lower Ureteric Stone

Overview

Background.
The efficacy of ESWL and ureteroscopy in the treatment of lower ureteric stone is still discussed. The aim of the study is to compare efficacy and safeness of both methods. 

Methods and Results.
A retrospective study comparing the treatment results of distal ureteric stones was performed. The inclusion criteria were: distal ureteric stones with no previous treatment and an accomplished three months follow-up after the treatment. There were 395 cases (390 patients) included in the ESWL group and 509 cases (501 patients) in the ureteroscopy group. Higher efficacy of ureteroscopy as opposed to ESWL therapy was marked. There is no significant difference in stone free rate in three months after the treatment (97.72 % vs. 98.40 %, p=0.4675), but there is a significant difference in EQ according to Rassweiler (43.52 vs. 89.60, p<0.0001). The main difference is in evaluation in 48 hours after the treatment (stone free rate 64.81 % vs. 96.46 %, p<0.0001). Ureteroscopy has a higher incidence of complications during the therapy 0.67 % vs. 6.36 %, p<0.0001) as well as after the therapy (6.55 % vs. 11.95 %, p=0.0018), but the complications are minor. On the contrary ESWL treatment is accompanied by a higher re-treatment rate (51 % vs. 2 %, p<0.0001) and higher incidence of auxiliary procedures (25.87 % vs. 6.36 %, p<0.0001). 

Conclusions.
It has been clearly proven that ureteroscopy is more efficient in the treatment of distal ureteric stones than ESWL. The main advantage of ureteroscopy is the immediate effect, low re-treatment rate and low incidence of auxiliary procedures, except the need of removing the J-J stent. The disadvantage of ureteroscopy is the requirement of general anaesthesia and a higher incidence of complications after the treatment, though only minor ones in most of the cases. 

Key words:
ureteric stone, therapy, ESWL, ureteroscopy.