Extracorporeal shock wave lithotripsy for ureteral calculi: Ten-year experience

Objective To evaluate the efficacy of extracorporeal shock wave lithotripsy(ESWL) in the management of pediatric ureteral calculi.Methods We reviewed the treatment and outcome of 67 patients with pediatric ureteral calculi.Clinical presentation,metabolic and anatomical anomalies,stone size and location,outcome and complications were analyzed.Ureteral stents were inserted in 52 patients for localization of the stone during ESWL.All the patients were followed-up for 3 to 9 months postoperatively.Results Of the 67 patients,43((64.2%)) were free of stones after 1 session of ESWL,7((10.4%)) after 2 sessions and 2((2.9%)) after three.The total stone-free rate is(77.6%).The stone-free rate following one ESWL session was 100% for ureteral calculi of 10mm or less in diameter regardless of the location.Of the 37 patients with stones larger than 10mm,23((62.2%))were free of stones following one ESWL session.The stone-free rate in the upper ureter is 92.0%,but in the mid and lower ureter,it was(69.0%).Of all the patients,11 underwent ureteroscopy and the residual stones were crushed by APL lithoclast.Three patients underwent ureterolithotomy after ESWL failure.Conclusions ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones.Ureteroscope was effective in managing mid and lower ureteral residual stones after ESWL.