Role of Ureteral Stents in Extracorporeal Shock Wave Lithotripsy of Ureteral Calculi

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most ureteral calculi above the sacroiliac joint, either after retrograde manipulation into the renal pelvis or in situ with a ureteral stent bypassing the calculus. In treating large renal calculi (diameter >25 mm), the use of double-J stents reduces the number of ancillary procedures needed in comparison with cases treated without the use of stents. It seemed probable that when treating ureteral calculi, the use of double-J stents would also reduce ancillary procedures. We examined this hypothesis by reviewing two groups of patients with ureteral calculi. In the first group of patients, a spiral-tip catheter was used to bypass the ureteral calculus, and the catheter was removed immediately after ESWL. In the second group, a double-J stent was used to bypass the ureteral calculus, and stent removal was delayed at least several days. Of the 116 patients studied, 49 received the spiral-tip caheter (ST) and 67 the double-J (DJ). After a single ESWL treatment, 98% of the ST group and 87% of the DJ group became stone free. In situ treatment of ureteral calculi was highly successful in our study, with 91% of all patients becoming stone free after a single ESWL treatment. Because the success rate in the ST group was 98%, we conclude that it is unnecessary to leave a double-J stent after lithotripsy when treating most ureteral calculi in situ.