THE TREATMENT OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR MIDDLE AND LOWER URETER STONES

Abstract

Ten patients with middle and lower ureter stones located under the 5th lumbar vertebra (L5), which were designated as primary middle and lower ureter stones, and 5 patients with the larger fragments located under the sacro-iliac joint after extracorporeal shock wave lithotripsy (ESWL) for upper ureter stones or renal calculi, which were designated as secondary lower ureter stones, were treated by ESWL. The patients were treated while sitting with a wedged pillow inserted behind their back, different from the treatment of renal calculi. Many patients were treated in combination with epidual (L₁-L₂) and sacral anesthesia. Four of 10 patients were treated with ureteral manipulation (ureteral catheter or ureteral balloon catheter). The fragments completely passed in all patients with primary middle and lower ureter stones. In four of the 5 patients with secondary middle and lower ureter stones, the fragments completely passed. The other with small fragments were followed in out patient clinic. None of the 15 patients treated by ESWL showed severe complications.
Our study demonstrated that ESWL was a safe and useful method for middle and lower ureter stones in addition to the upper ureter stones and renal calculi. ESWL was performed at least twice in patients with middle or lower ureter stones. Transurethral ureterolithotripsy and surgical prosedure should be performed in unsuccessful cases.