Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach?

To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one.

This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments (< 3 mm) for a maximum of three sessions. The success rate, rate of complications, pain intensity by visual pain scale and patients' satisfaction rate were compared among the three study groups.

Data of 240 patients were analyzed (80 in each group). Overall, no significant difference has been observed among all groups regarding demographic data, stone and treatment characteristics. The overall success rates for treatment after the last session were 86.3%, 65% and 62.5% in the three study groups, respectively, with a statistically significant difference for group A. Regarding pain perception and complication rate, all groups were comparable. Patient satisfaction is significantly better in group A versus the other two groups.

Our study has confirmed better efficacy profile and patients' satisfaction rate of ESWL in the supine position (transgluteal approach) than other different known approaches for the treatment of distal ureteral stones.