Extracorporeal Shock Wave Lithotripsy of Distal-Ureteral Calculi: Is It Worthwhile?

Among 44 patients with distal-ureteral stones, 32 had no contraindications to extracorporeal shock wave lithotripsy (ESWL); i.e., they were not women of childbearing age and did not have ipsilateral renal stones. All these patients underwent simulation for ESWL. In 18 patients, it proved possible to localize the stone, and in 16 of these ESWL was successful. In the other two, localization was not possible at the start of ESWL, and ureteroscopy was used to remove the stones. In the 15 patients in whom simulation failed, the stone was moved up the ureter for ESWL in eight and was removed ureteroscopically in seven. In the eight women of childbearing age, the stone was moved out of the pelvis for ESWL in five and removed ureteroscopically in three. All three of the patients with ipsilateral renal stones underwent ESWL after manipulation of the stone. Thus stones were ultimately removed by ESWL in 32 of the 44 patients. ESWL can be used for distal-ureteral stones, although it is less straightforward than for stones else-where in the urinary tract.