Outcome of SWL for Lower Ureteric Calculi

Objective To determine the efficacy of extracorporeal shock-wave lithotripsy (SWL) in the treatment of lower ureteric calculi.Materials and methods Patients with lower ureteric calculi selected for treatment by SWL from July 2006June 2011 were analyzed retrospectively. Outcomes assessed were stone clearance, complications and retreatment including the need for ureteroscopy. Complications like sepsis, hydronephrosis and deterioration of renal function were documented. Indications for ureteroscopy included failure of fragmentation and failure to clear fragments at follow up. Results A total of 59 patients were studied. There were 51 males and 8 females with age ranging from 19 - 74 years (mean age 43 years). Thirty seven patients had left sided calculi, 21 right sided and one patient had bilateral lower ureteric calculi. The size of the calculi ranged from 5 to 15 mm (mean size 8.44 mm). The number of shocks ranged from 2000 to 8000 (mean no. of shocks 4449). The duration of follow up varied from 2 to 30 days (mean 11.4 days). Ureteroscopy was required in 11 patients. 44 of patients with stone size in the range 11-15 mm required ureteroscopy. Of the 11 patients, six had ureteroscopy for failure to fragment and five for failure of clearance. There was no reported UTI or deterioration of renal function during the study. Conclusion SWL is a safe effective treatment for lower ureteric calculi of size less than 10 mm. But for larger stones (10mm), the rates of failure and need for intervention is higher.