NEW YORK (Reuters Health) - In general, shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) are equally effective in treating large upper third ureteral stones, new research suggests. However, if severe hydronephrosis is present, URSL can provide definitive treatment, whereas SWL cannot. However, pain scores, hospital stays and the cost-effectiveness index were all greater with URSL.

The findings, which appear in the March issue of Urology, are based on a study of 35 men and 7 women who were randomized to undergo SWL or URSL for a solitary, radiopaque upper ureteral stone of at least 1.5 cm in diameter.

The mean patient age was 53.1 years and the average stone length in each treatment group was similar -- about18 cm.

SWL and URSL were similarly effective in promoting stone resolution and preventing the need for retreatment or an auxiliary procedure, lead author Dr. Ying-Huei Lee, from Chi Mei Medical Center in Tainan, Taiwan, and colleagues note. URSL, however, was associated with a greater cost-effectiveness index, treatment time, pain score, and hospital stay.

As noted, the degree of hydronephrosis affected the success of SWL. With severe hydronephrosis, URSL offered the potential for stone resolution, whereas with SWL auxiliary surgical procedures were invariably required.

The results suggest that either SWL or URSL are suitable options for most patients with large upper third ureteral stones, the authors note. "We strongly suggest that understanding the cost-effectiveness, success rate, pain score, and patient satisfaction score between the two different approaches constitutes an indispensable requisite for choosing the optimal first-line therapeutic strategy for patients with large upper third ureteral stones."

Urology 2006;67:480-484

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