Extracorporeal and contact ureterolithotripsy in the treatment of big stones in upper third of the ureter

Today for the treatment of the ureteral stones besides the open, laparoscopic and retroperitoneoscopic ureterolithotomy many other methods are available, such as extracorporeal (ESWLT) and contact ureterolithotripsy (CULT) using a transurethral approach. The autors has analyzed retrospectively and prospectively the results of the treatment in 615 patients with big ureteral stones (more than 1 cm) of the upper third, which have undergone the CULT (196 patients) and ESWLT (419 patients) during the period of 2006-2009 years. Preoperatively all patients had a thorough clinical and laboratory investigation, which showed a presence of the large stone in the upper third of the ureter. The results of the CULT and ESWLT were analyzed according to the stone size: 1-1.5 cm, 1.6-2.0 cm and exceeding 2 cm. As the result of the CULT completely stone-free rate (SFR) were 147 patients (75%), among them SFR were 84% of the patients with the stone size 1-1.5 cm, 69.2% with the stones 1.6-2 cm and 54.5% with the stones more than 2 cm. After 1-4 sessions of the ESWLT completely SFR were 289 patients (68.9%), among them with corresponding stone sizes - 69.9%, 64.6% and 50%. It was shown, that stone size was a main predictor of the efficacy of the CULT and ESWLT in the treatment of the big stones of the upper third of the ureter, at that the efficacy of the one session of the CULT is much more resulting than 1 session of the ESWLT and this was not dependent on the stone size.