TO COMPARE THE EFFICACY OF URETEROSCOPIC LITHOTRIPSY VERSUS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY IN THE TREATMENT OF PROXIMAL URETERIC STONES OF SIZE BETWEEN 10MM TO 15MM.

Abstract

BACKGROUND: The overall probability that an individual will form stones varies in different regionsof the world. The risk of having urinary tract stones in the developed country populations is between 10-15%. The prevalence of urinary tract stone disease is 13% for adult males and 7% among the females.Most of the patients with ureteric stones present with colicky pain, however some may be asymptomaticand are identified on routine assessment. Large stones typically require active treatment. Stones that donot pass can be removed by different treatment modalities such as Extracorporeal shock wave lithotripsy(ESWL), Ureteroscopic lithotripsy (URSL) and open or laparoscopic ureterolithotomy.OBJECTIVE: To compare the efficacy of Ureteroscopic lithotripsy versus extracorporeal shockwavelithotripsy in the treatment of proximal ureteric stones of size between 10mm to 15mm.MATERIALS AND METHODS: This was a randomized control trial of 138 human subjects,conducted at Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex,Peshawar. Total sample size was based on the previously reported stone clearance rates for proximalureteric stones (88% URSL12 and 67.5% for ESWL11), 95% confidence interval and power of 90%.RESULTS: In this study mean age was 47.36 years SD +15.4. Fifty nine percent patients were male and41% patients were female. Eighteen percent patients had stone size 10mm, 19.6% patients had stone size11mm, 19.6% patients had stone size 12mm, 16.7% patients had stone size 13mm, 13.6 patients hadstone size 14mm, 11.6% patients had stone size 15mm. ESWL was effective in 65.2% and was notsuccessful in 34.8%, while in the URSL group 84.1% were treated successfully and in 15.9% patientswith proximal ureteric stones the stone clearance efficacy was not effective.CONCLUSION: Both URSL & ESWL are well accepted minimally invasive modalities of treatmentfor proximal ureteric stones. We conclude that URSL has yielded superior results as compared to theESWL group in treatment of patients with proximal ureteric stones of size 1-1.5cm.KEY WORDS: Ureteroscopic lithotripsy, extracorporeal shockwave lithotripsy, proximal ureteric stones.