A COMPARATIVE STUDY OF SUPINE TRANSGLUTEAL EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND URETEROSCOPY FOR THE MANAGEMENT OF DISTAL URETERIC STONES

The ureteral calculus in general presents as acute colicky pain and the aim of treatment is to achieve complete stone clearance with minimal morbidity for the patient. Of the available treatment options for the management of lower ureteric stones, semirigid ureterorenoscopy with intracorporeal lithotripsy has the best results with little morbidity. However, ESWL is a safe and non-invasive technique with minimal morbidity. We have studied the outcomes of ESWL for distal ureteric stones and compared it with the ureterorenoscopy which is the current modality of choice. METHODS A total of 120 patients were included in the study. They were randomly divided into two groups by an independent observer into group A (70 patients) and group B (50 patients). The patients in group A were managed by supine transgluteal ESWL as described below and those in group B were managed by semirigid ureteroscopy. Patients were followed up at 15 days, 30 days and 90 days. Failure was defined as the presence of fragments of any size in the followup film 3 months after the final ESWL session. RESULTS The demographic parameters and stone characteristics were comparable between the two groups. In our study, overall stone free rate at three months was 93.8% (107/114). Clearance in the ESWL group was 89.4% (59/66) and in the URS group was 100% (48/48). This difference; however, was not statistically significant. However, there was an increased incidence of complications in the URS group, (24.2% vs. 39.6%), though most of the complications were mild requiring no active intervention. This difference was also not statistically significant (p=0.10). CONCLUSION Supine transgluteal SWL for distal ureteric stones, the results are comparable with that of ureteroscopy with intracorporeal lithotripsy with specific advantages in carefully selected patients. It can be recommended as a non-invasive alternative for patients who are not fit or unwilling for surgery.