The efficiency of combined methods of lithotripsy for ureteral stones

Extracorporeal shockwave lithotripsy (ESWL) is the first line treatment of uncomplicated upper ureteral stones. Ureterorenoscopy with contact lithotripsy (URS) are useful for middle and lower ureteral stones. However, the presence of residual calculi, the stone fragments migration and the formation of “steinstrasse”, when using those methods separately, prompts employing combination of lithotripsy modalities. The aim of this article is to find out the optimal combination of stone disintegration methods. The study compared the use of lithotripsy as stand - alone methods with their combined application. All patients were divided into 3 groups: group 1 - 131 patients with lower ureteral stones, group 2 - 45 patients with middle ureteral stones, group 3 - 48 patients with upper ureteral stones. A secondary intervention was required in 9.2% of cases with lower ureteral stones, in 51.1% of cases with middle ureteral stones and 43.75% of cases with upper ureteral stones. In our cases such number of patients required repeated interventions are most likely associated with frequent stone migration in pyelocaliceal system and residual stones after ESWL. On the other hand, it is related to achieve of urinary tracts “stone free condition” within one hospitalization in accordance with recent guidelines. The effectiveness of extracorporeal shockwave lithotripsy is significantly affected by the composition of the stones. Usage flexible ureterorenoscopy and percutaneous nephrolithotripsy based upon laser lithotripsy enables to achieve clinical effectiveness regardless of the density and location of the stones.

extracorporeal shock wave lithotripsy, contact lithotripsy, ureterorenoscopy, combined lithotripsy