Extracorporeal shockwave lithotripsy vs ureteroscopic laser lithotripsy for management of lower ureteral calculi: a prospective study

Objective To compare the efficacy and safety of extracorporeal shock wave lithotripsy( ESWL) and ureteroscopic laser lithotripsy( URL) in management of lower ureteral calculi. Methods One hundred and forty three patients with lower ureteral calculi were enrolled in a prospective trial from February 2013 to January 2014. The treatment modality chosen for an individual was primarily based on patient choice: 35 patients underwent ESWL and 107 patients underwent URL. The electromagnetic lithotripter was used for ESWL and double-frequency laser was used for URL. Patients in both groups were compared for overall stone-free rates( SFR),complication rates and costs after 4 weeks. A subgroup analysis was performed in both groups according to stone size of 10 mm or ≥10 mm.Results Compared with ESWL group,the success rate on one session and overall SFR in URL group was significantly higher,and the re-treatment rate was significantly lower( P 0. 05),whereas the average treatment time was significantly shorter and the cost was lower in ESWL group( P 0. 05). In ESWL group,the efficacy was significantly higher in patients with stones 10 mm( P 0. 05) than that with stones ≥10 mm,however thare was no statistical differences between two subgroups in the URL groups. In patients with stones ≥10 mm treated with URL,the efficacy was significantly higher for those treated with ESWL( P 0. 05). There was no significant difference in incidence of complication between two groups and subgroups. Conclusion For the management of lower ureteral calculi,URL has a better therapeutic effect than ESWL. ESWL can be the preferred for patients with lower ureteral calculi 10 mm and URL can be reserved for patients with stones of ≥10 mm.