Treatment of Ureteral Calculis:Comparison Between Ureteroscopy with Holmium YAG Laser Lithotripsy and Extracorporeal Shock Wove Lithotripsy

Objective To compare the safety and efficacy of ureteroscopy with holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy(ESWL) for ureteral calculi.Methods Eighty patients underwent ureteroscopy with holmium:YAG laser lithotripsy including 42 patients with calculi 1 cm or greater and 38 patients with calculi less than 1 cm in diameter.Eighty-two patients underwent ESWL,including 42 patients with calculi 1 cm or greater and 40 patents with calculi less than 1 cm.The operation time,stone-free rate and incidence rate of complications were compared between the 2 groups.Results The mean oeration time of ureteroscopy with holmium;YAG laser lithotripsy for calculi 1 cm or greater and less than 1 cm was(56.0±2.3) min and (39.0±1.8) min respectively,which were shorter than(73.0±4.5) min and(54.0±2.1) min with ESWL(both P0.01).The stone-free rate after 1 months in patints with 1 cm or greater stone was 92.9% for ureteroscopy with holmium:YAG laser lithotrlpsy.It was higher than 65% with ESWL(P0.01).As for calculi less than 1 cm,the stone-free rate with holmium:YAG laser lithotrlpsy and ESWL were 89.5% and 83.3% respectively(P0.05).The complication rate was 3.75% in the group of ureteroscopy with holmium:YAG laser lithotripsy,while in the ESWL group no complication occurred.Conclusion Our study demonstrates that ureteroscopy with holmium:YAG laser lithotripsy for calculi 1 cm or greater in diameter and middle.distal ureteral calculi is more efective than ESWL,but no diference between the 2 groups for calculi less than 1 cm.ESWL can be used as the first-line therapy for calculi less than 1 cm in diameter and proximal ureteral calculi.