New Lithostar treatment technique for difficult upper ureteral stones

In situ treatment of ureteral stones with the Siemens Lithostar is highly successful. In a rare patient, however, despite various positioning maneuvers, an upper ureteral or lower pole renal stone overlies vertebral bone when the shock head is raised. Unless the patient chooses to delay treatments until the stone has moved distally, such patients would ordinarily be forced to undergo percutaneous stone manipulation or ureteroscopy. We describe a technique to facilitate in situ Lithostar treatment of these uncommon but vexing upper ureteral stones using the contralateral shock head with stone side-posterior oblique positioning. Nine of ten patients were stone free at 3 months without further treatment.