Should Upper Ureteral Calculi be Manipulated before Extracorporeal Shock Wave Lithotripsy? A Prospective Controlled Trial

AbstractWhether all upper ureteral stones must be manipulated before extracorporeal shock wave lithotripsy (ESWL**Dornier Medical Systems, Marietta, Georgia.) is an ongoing controversy. In a prospective trial, symptomatic patients with solitary upper ureteral calculi less than 1 year in duration were alternated between ESWL in situ and pre-ESWL stone manipulation. Pretreatment excretory urograms were assessed for stone size and degree of proximal hydroureteronephrosis, which was graded from zero (no dilatation) to 3 (severe dilatation). Stone manipulation was done with the patient under intravenous sedation and local anesthesia. A total of 4,000 shock waves was given in a single session using Siemens Lithostar Plus, and treatment was repeated on days 4, 15 and 30 if required. The patients were evaluated 3 months after onset of therapy with excretory urogram and urine culture.Seventy patients qualified for the study (group 1—35 in situ and group 2—35 stone manipulation) and were comparable in relation to a...