• Bakhtawar Gul Wazir
  • Akhtar Nawaz Orakzai
  • Ahmad Nawaz


Background: Ureteric stones greater than 6mm require intervention. Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) with intra-corporeal lithotripsy (ICL) are two least invasive therapies. Both show acceptable stone clearance. What should be the first line of treatment in distal ureteric stones? We conducted this study to compare the efficacy of ESWL and pneumatic ICL in order to develop clear cut treatment guidelines. Methods: This randomized control trial was conducted at Institute of Kidney Diseases, Peshawar from June 2011 to June 2012. Two hundred and twenty-four patients with distal ureteric stones 6–12 mm in size were included. Patients were randomized into two groups. Group-A patients were treated with URS plus ICL and Group-B with ESWL. Patients were evaluated for stone clearance after 2 weeks, with X-ray KUB and ultrasound. All the data were recorded in a pro forma and analysed in SPSS 10. Fisher’s exact test was applied to compare the efficacy and a p-value of 0.05 was considered significant. Results: Out of 112 patients in Group-A, 75 (67%) were males and 37 (33%) were females while in Group-B 79 (70.5%) were males and 33 (29.5%) were females. The mean age in Group-A was, 48.73±16.23 years whereas it was 46±14.58 years in Group-B. Overall, mean age was 47.36±15.4 years. Mean stone size was 9.18±1.6 mm. At follow up (2 weeks post-operative) URS with ICL was successful in 101 (90.2%) patients while ESWL was successful in 75 (67%) patients (p-value=0.0001). Conclusion: Extracorporeal shockwave lithotripsy shows acceptable stone clearance but ureteroscopy with intra-corporeal lithotripsy shows superior results in distal ureteric stones.Keywords: Pneumatic lithotripsy, ureteral calculi, ureteroscopy, extracorporeal shockwave lithotripsy


Krambeck AE, Murat FJ, Gettman MT, Chow GK, Patterson DE, Segura JW. The evolution of ureteroscopy: A Modern Single-Institution Series. Mayo Clin Proc 2006;81:468–73.

Tchey D, Ha YS, Kim WT, Yun SJ, Lee SC, Kim WJ. Expected management of ureteric stones: Outcome and clinical factors of spontaneous passage in a single institution’s experience. Korean J Urol 2011;52:847–51.

Ghalayini IF, Al-Ghazo MA, Khader YS. Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: Efficacy and patient satisfaction. Int Braz J Urol 2006;32:656–67.

Nomikos MS, Sowter SJ, Tolley DA. Outcomes using a fourth-generation lithotripter: a new benchmark for comparison? BJU Int 2007;100:1356–60.

Nabi G, Downey P, Keeley F, Watson G, McClinton S. Extra-corporeal shock wavw lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2007;CD006029.

Tipu SA, Malik HA, Mohhayuddin N, Sultan G, Hussain M, Hashmi A et al. Treatment of Ureteric Calculi- Use of Holmium: YAG Laser Lithtripsy versus Pneumatic Lithoclast. J Pak Med Assoc 2007;57:440–43.

Elganainy E, Hameed DA, Elgammal MA, Abd-Elsayed AA, Shalaby M. Experience with impacted upper ureteral stones; should we abandon using semi-rigid ureteroscopes and pneumatic lithoclast. Int Arch Med 2009;2:13.

Tan PK, Tan SM, Consiglire D. Ureteroscopic lithoclast lithotripsy: a cost effective option. J Endourol 1998;12:341–4.

Nikoobakht MR, Emamzadeh A, Abedi AR, Moradi K, Mehrsai A. Transureteral Lithotripsy Versus Extracorporeal Shock Wave Lithtripsy in Management of Upper Ureteral Calculi. Urol J 2007;4:207–11.

Brito AH, Mitre AI, Srougi Miguel. Ureteroscopic Pneumatic Lithotripsy of Impacted Ureteral Calculi. Int Braz J Urol 2006;32:295–9.

Muslumanoglu AY, Tefekli AH, Altunrende F, Karadag MA, Baykal M, Akcay M. Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children. Int Urol Nephrol 2006;38:225–9.

Bromwich EJ, Lockyer R, Keoghane SR. Day-case rigid and flexible ureteroscopy. Ann R Coll Surg Engl 2007;89:526–8.

Chen JJ, Yip SK, Wong MY, Cheng CW. Ureteroscopy as an out-patient procedure: the Singapore General Hospital Urology Center experience. Hong Kong Med J 2003;9:175–8.

Hofmann R. Ureteroscopy (URS) for ureteric calculi. Urologe A 2006;45:637–46.

Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006 Mar;20(3):179–85.

Hong YK, Park DS. Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteric Calculi: 12-Years’ Experience. J Korean Med Sci 2009;24:690–4.

Ather MH, Nazim SM, Sulaiman MN. Efficacy of semirigid ureteroscopy with pneumatic lithotripsy for ureteral stone surface area of greater than 30 mm2. J Endourol 2009;23(4):619–22.