Ureteral calculi: natural history and treatment in an era of advanced technology

Patients with ureteral stones may be managed expectantly, or treated with a variety of invasive and noninvasive techniques depending on stone composition, size and location, expectations of the patient and experience of the surgeon. Of 378 patients with documented ureteral calculi 60% passed the stones spontaneously. Passage rates from the proximal, middle and distal ureter were 22, 46 and 71%, respectively. Basketing under fluoroscopic control of distal stones was successful in 79% of the attempts and for those in whom this approach failed ureteroscopy was performed, with a success rate of 90%. When ureteroscopy was used as the initial treatment of distal stones removal was achieved in 81% of the patients. These statistics serve as a reminder that traditional therapy of ureteral stones has not lost its role in contemporary practice.