A prospective randomized study of two treatments for upper ureteral calculi below transverse process of L₄

ObjectiveTo compare the efficacy and safety between extracorporeal shock wave lithotripsy(ESWL) and ureteroscopy(URS) in the treatment of upper ureteral calculi below the transverse process of L₄.

MethodsA total of 158 patients with upper ureteral calculi(length diameter 1.0- < 2.0 cm) below the transverse process of L₄ were randomly divided into the ESWL group(80 cases) and URS group(78 cases), Two groups were subdivided into the < 1.3 cm group and ≥1.3 cm group according to the length diameter of calculi.The one-time lithotripsy success rate, final lithotripsy success rate, costs stone calculi and complications were compared between two groups.

ResultsThe one-time lithotripsy success rate and medical expenses in ESWL group were lower than those in URS group, and the repeated treatment rate in ESWL group was higher than that in URS group(P < 0.01).There was no statistical significance in the final lithotripsy success rate and incidence rate of complications between two groups(P>0.05).In ESWL group, the one-time lithotripsy success rate and final lithotripsy success rate in patients with calculi diameter ≥1.3 cm were lower than those in patients with calculi diameter < 1.3 cm(P < 0.01).In URS group, the difference of the lithotripsy success rate between two subgroups was not statistically significant(P>0.05).For the calculi with diameter ≥1.3 cm, the one-time lithotripsy success rate and final lithotripsy success rate of URS were higher than those of ESEWL(P < 0.01 and P < 0.05).For the calculi with diameter < 1.3 cm, the difference of the curative effect between ESWL and URS was not statistically significant(P>0.05).There was no statistical significance in the incidence rate of complications within and between subgroups(P>0.05).

ConclusionsFor the management of upper ureteral calculi below the transverse process of L₄, URS can be preferred for patients with calculi diameter 1.3- < 2.0 cm, and ESWL can be suited for patients with calculi diameter 1.0 < 1.3 cm.