الفهرس 
? Anatomy of UreterOnly 14 pages are availabe for public view
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Abstract
his study was performed at Ain Shams University (Urology department) and El Doaah hospital (Urology department), from August 2016 to August 2017, a total of 50 patients having solitary radiopaque middle ureteral stone ranges between 0.5 – 1.5 in size were divided into two groups 25 patients each enrolled in our prospective study.
All patients were subjected to preoperative evaluation in the form of full history, physical examination, laboratory investigations.
Patients of the first group were treated by URS with Trans-ureteral pneumatic lithotripsy (Swiss lithoclast) while patients of the second group were treated with ESWL (Dornier lithotripter S).
The aim of our study was to compare efficacy, stone-free rate, cost effect, retreatment rates, associated complications (intra-operative and post-operative), operative duration and hospital stay between ESWL and semi rigid URS in mid-ureteric stones range 0.5-1.5 in size.
The results of the study were:
In this study the overall stone free rate was considered after three sessions of ESWL (in case of ESWL group) or one trial of ureteroscopy (in case of URS group).
ESWL group: 14 cases became stone free after the first session, while, 6 cases became stone free after the second session and ESWL failed in 5 cases and they were successfully managed by ureteroscopy.
URS group: 23 cases became stone free after first ureteroscopy, while the remaining 2 patients failed to become stone free due to proximal migration of the stone.
In ESWL group, patients were already at outpatient clinic so there were no admission or hospital stay, all cases done without anesthesia, just analgesic ± sedation.
While in URS group patients admitted and the hospital stay varies from one day to seven days according to the condition of the case, all URS cases had Spinal anesthesia
ESWL was shown to be less time consuming than URS with a mean operative time of 46.84±3.61 minutes versus 56.20±7.11 minutes respectively.
In URS group there were 22 patients had ureteric catheter inserted for 24 to 72 hours postoperatively and 3 patients had double (J) stent inserted for 4 weeks postoperatively, while all the patients who underwent ESWL, no auxiliary procedure done as this procedure is completely non-invasive.
Among ESWL cases, No case had an intra-operative complication, while URS group had 3 cases of intra-operative complication.
There were 4 cases who had post-operative complications among ESWL group, while there were 5 cases who had post-operative complications among URS group.
Conclusion:
In treatment of mid-ureteral stones range 0.5-1.5 in size, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone free rate and it provides immediate stone clearance with lower re-treatment rates and higher patient satisfaction, but URS requires anesthesia, longer hospitalization, and associated with a higher incidence of complications.
ESWL can be a good alternative for ureteroscopy as ESWL has advantages of non-invasiveness, shorter operative time, lower cost, no hospital stay as it can be performed on an outpatient basis, quicker convalescence, no need for ureteral stent insertion and no need of anesthesia with fewer complication, ESWL often requires multiple treatment sessions and most of patients needed frequent follow-up visits.
Treatment decisions have to be drawn individually taking into account patient’s preference for earlier stone-free status, acceptance of invasive procedure, physical health, personal experience and local equipment. We believe that ureteroscopy is preferable to ESWL for treatment of mid-ureteral calculi since it is significantly more efficient with higher patient satisfaction.
Take Home Message:
Increased success rate of rigid ureteroscopy treatment more than Extracorporeal shockwave lithotripsy in treatment of middle ureteric stones range 0.5 - 1.5 cm in size, even with their intraoperative and postoperative complications