The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser

Main Article Content

Kashif Bangash
Arsalan Riaz
Hassan Mumtaz
Farrukh Zaman
Fayyaz Haider Ali
Khursheed Anwar
Inam Malkani
Muhammad Danish Qureshi


ESWL, Proximal ureteric Stones, ureterorenoscopic, manipulation.


Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage.
Our aim was to compare the efficacy & the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave litho-tripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size).
This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic.
The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P > 0.05). Male patients were three times at a higher risk of recurrence as compared to females.
This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size).


Download data is not yet available.
Abstract 112 | PDF Downloads 25 XML Downloads 15 HTML Downloads 12


1. Abdel Razzak OM. In: Smith AD, Badlani GH, Bagley MDD, editors. Smith’s textbook of endourology 2nd ed. Ureteral Anatomy; 2006. Smith-s-Textbook-of-Endourology-2Ed-2006-Arthur-D-Smith-Gopal-H-Badlani-MD-Demetirus-H
2. Binbay M, Tepeler A, Singh A, Akman T, Tekinaslan E, Sarilar O, et al. Evaluation of pneumatic versus holmium: YAG laser lithotripsy for impacted ureteral stones. Int Urol Nephrol. 2011;43(4):989–995.
3. Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. Invest Clin Urol. 2017;58(5):299–306.
4. Serinken M, Eken C, Erdemir F, Eliçabuk H, Bas¸er A. The reliability of national videos related to the kidney stones on YouTube. Turk J Urol. 2016;42(1):7.
5. Dede O, S¸ener NC, Bas¸ O, Dede G, Bag?banc? MS¸. Does morbid obesity influence the success and complication rates of extracor-poreal shockwave lithotripsy for upper ureteral stones? Turk J Urol. 2015;41(1):20.
6. Nielsen TK, Jensen JB. Efficacy of commercialised extracor-poreal shock wave lithotripsy service: A review of 589 renal stones. BMC Urol. 2017;17(1):59.
7. Jhanwar A, Bansal A, Sankhwar S, Kumar M, Kanodia G, Prakash G. Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: A prospective study. Int Braz J Urol. 2016;42(6):1178–1182. ibju.2016.0211
8. Park J, Kim H-W, Hong S, Yang HJ, Chung H. Comparison of treatment outcomes according to output voltage during shock-wave lithotripsy for ureteral calculi: A prospective randomized multicenter study. World J Urol. 2015;33(5):609–615. https://doi. org/10.1007/s00345-014-1438-7
9. Eze KC, Irekpita E, Salami T. Cost-effectiveness of extracor-poreal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience. Niger Med J. 2016;57(1):44.
10. Geraghty RM, Jones P, Somani BK. Worldwide trends of urinary stone disease treatment over the last two decades: A systematic review. J Endourol. 2017;31(6):547–556.
11. Manzoor S, Hashmi AH, Sohail MA, Mahar F, Bhatti S, Khuhro AQ. Extracorporeal shock wave lithotripsy (ESWL) vs. ureterorenoscopic (URS) manipulation in proximal ureteric stone. J Coll Physicians Surg Pak. 2013;23(10):726–730.
12. Preminger GM, Tiselius H-G, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178(6):2418–2434.
13. Ghalayini IF, Al-Ghazo MA, Khader YS. Extracorporeal shock-wave lithotripsy versus ureteroscopy for distal ureteric calculi: Efficacy and patient satisfaction. Int Braz J Urol. 2006;32(6):656– 667.
14. Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A prospective randomized comparison between laparoscopic ureterolithotomy and semirigid ureteroscopy for upper ureteral stones > 2 cm: A single-center experience. J Endourol. 2015;29(11):1248–1252.
15. Iqbal N, Assad S, Bhatti JRA, Hasan A, Shabbir MU, Akhter S. Comparison of extracorporeal shock wave lithotripsy for urolithiasis between children and adults: A single centre study. Cureus. 2016;8(9):e810.
16. Lee Y-H, Tsai J-Y, Jiaan B-P, Wu T, Yu C-C. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology. 2006;67(3):480–484.
17. Iqbal N, Malik Y, Nadeem U, Khalid M, Pirzada A, Majeed M, et al. Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience. Turk J Urol. 2018;44(3):221.
18. Hatroom AAS. Extracorporeal shock wave lithotripsy and ureterorenoscopy procedures of ureteric stone disease in patients with a solitary kidney in Aden. Dev Prim Health Care Syst State Qatar. 2019;7(10):12.
19. Trinchieri A. Epidemiology of urolithiasis: An update. Clin Cases Miner Bone Netabol. 2008;5(2):101.
20. Tanthanuch M, Apiwatgaroon A, Pripatnanont C. Urinary tract calculi in southern Thailand. J Med Assoc Thai. 2005;88(1):80–85.
21. Qaader D, Yousif S, Mahdi L. Prevalence and etiology of urinary stones in hospitalized patients in Baghdad. Eastern
Mediterranean Health J. 2006;12(6):853–861.
22. Khan AS, Rai ME, Pervaiz A, Shah AH, Hussain AA,
Siddiq  M. Epidemiological risk factors and composition of urinary stones in Riyadh Saudi Arabia. J Ayub Med Coll Abbottabad. 2004;16(3):56–58.
23. Salem HK. A prospective randomized study comparing shock wave lithotripsy and semirigid ureteroscopy for the management of proximal ureteral calculi. Urology. 2009;74(6):1216–1221.
24. Fong Y, Ho S, Peh O, Ng F, Lim P, Quek P, et al. Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proxi-mal ureteric calculi-a comparative assessment of efficacy and safety. Ann Acad Med Singapore. 2004;33(1):80–83.
25. Wu C-F, Shee J-J, Lin W-Y, Lin C-L, Chen C-S. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium: YAG laser lithotripsy for treating large proximal ureteral stones. J Urol. 2004;172(5):1899– 1902.
26. Murota-Kawano A, Ohya K, Sekine H. Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: Efficacy of the third generation lithotripter as the first line treatment. Int J Urol. 2008;15(3):210–215.
27. Tawfick ER. Treatment of large proximal ureteral stones: Extra corporeal shock wave lithotripsy versus semi-rigid uretero-scope with lithoclast. Int Archi Med. 2010;3(1):3.
28. Robert M, A’ch S, Lanfrey P, Guiter J, Navratil H. Piezoelectric shockwave lithotripsy of urinary calculi: Comparative study of stone depth in kidney and ureter treatments. J Endourol. 1999;13(10):699–703.
29. Marguet C, Springhart W, Auge B, Preminger G. Advances in the surgical management of nephrolithiasis. Minerva urologica e nefrologica = Italian J Urol Nephrol. 2004;56(1):33–48.
30. Lifshitz DA, Lingeman JE. Ureteroscopy as a first-line intervention for ureteral calculi in pregnancy. J Endourol. 2002;16(1):19– 22.

Most read articles by the same author(s)