Treatment of ureteral calculi:comparison between ureteroscopy with holmium:YAG laser lithotripsy and extracorporeal shock wave 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 159 patients (168 sides) underwent ureteroscopy with holmium:YAG laser lithotripsy,including 76 sides of calculi 1 cm or greater and 92 sides of calculi less than 1 cm in diameter.319 patients (334 sides) underwent ESWL,including 143 sides of calculi 1 cm or greater and 191 sides of 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 operation time of ureteroscopy with holmium:YAG laser lithotripsy for calculi 1 cm or greater and less than 1 cm was 58 min and 43 min,respectively,which were shorter than 68 min and 56 min with ESWL (both P 0.01). The stone free rate after 3 months in patients with 1 cm or greater stone was 92% for ureteroscopy with holmium:YAG laser lithotripsy. It was higher than 61% with ESWL ( P 0.01). As for calculi less than 1 cm, the stone free rate with holmium:YAG laser lithotripsy and ESWL were 95% and 85%,respectively ( P 0.05).The complication rate was 4.8% (8/168) in the group of ureteroscopy with holmium:YAG laser lithotripsy,while in ESWL group no complication occurred. Conclusions Our study demonstrates that ureteroscopy with holmium:YAG laser lithotripsy for calculi 1 cm or greater in diameter is more effective than ESWL,but no difference 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.