BJU International (1999), 84, 770–774 Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third-generation lithotripter V.J. GNANAPRAGASAM, P.D.R. RAMSDEN, L.S.N. MURTHY* and D.J. THOMAS Department of Urology and *Radiology, Freeman Hospital, Newcastle upon Tyne, UK Objective To review the results of primary in situ cations. Stone-free rates were 90% for upper ureteric, 89% for middle-third and 86% for lower-third calculi. extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones using a third-generation Twenty-one patients required auxiliary procedures in the form of JJ stenting or nephrostomy. Failure of lithotripter, the Dornier MFL 5000 (Dornier Medizentechnic, Germany). ESWL was associated with stone size (>1.3 cm) but not location or inadequate treatment. Patients and methods The study comprised a retrospec- tive review of treatment outcome in 180 patients with Conclusion Where prompt access to ESWL is available, primary in situ ESWL remains an eCective form of 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and treatment for all ureteric calculi, although stone-free rates are lower for larger stones. establishing reasons for failure. Results At the 3-month follow-up, 88% of patients were Keywords Extracorporeal shock wave lithotripsy, Dornier MFL 5000, ureteric calculi stone-free; 21 patients failed ESWL and were treated by ureteroscopic stone extraction with no compli- whether results were comparable with those published Introduction and to determine whether any subgroups of patients would be best managed by ureteroscopy. Despite the introduction of guidelines for the treatment of ureteric calculi, treatment remains controversial. With the advent of small 7.5 F semirigid ureteroscopes, flexible Patients and methods ureteroscopes and laser lithotripsy, some endourologists make a case for routine ureteroscopic treatment for all In a retrospective study, 202 patients were identified who had received ESWL for ureteric calculi. Complete ureteric stones requiring treatment, on the grounds that it is more cost-eCective. However, ESWL remains an case-notes and X-rays were obtained for 180 patients (46 females and 134 males). All patients were treated eCective, well-established method of treating ureteric calculi [1–3]. Although ESWL was initially restricted to with a third-generation Dornier MFL 5000 lithotripter (Dornier Medizentechnic, Germany) using X-ray localiz- stones in the proximal ureter, with the development of fluoroscopic imaging, stones can be located and treated ation; 112 patients’ left-sided stones and 68 right-sided, with 138 patients treated electively and 42 as emerg- throughout the ureter. The results of in situ ESWL have been reported in many prospective and retrospective encies. Patients presenting with ureteric obstruction and infection were managed initially by nephrostomy or studies, with success rates for overall stone-free clearance of 80–90% [4,5]. In many centres, ESWL remains the ureteric stenting, with or without ureteroscopy and stone extraction. Patients with uncomplicated stones of primary mode of therapy for patients with ureteric calculi, with ureteroscopy reserved for treatment failures ∏5 mm in diameter were initially treated conservatively. The groups of patients with ureteric stones were referred or very large stones. The success of lithotripsy may be influenced by several factors, including stone chemistry, by urologists across the Northern Region and there is undoubtedly an element of selection bias. However, the position and size. In the light of the recent trend towards ureteroscopy sample serves to show the results that can be obtained in this selected group of patients. Of the emergency and intracorporeal lithotripsy, we reviewed a series of patients with ureteric calculi treated by ESWL to establish group, 22 had ureteric stents inserted before lithotripsy and five had a nephrostomy in situ before referral. Most patients (172) required intravenous analgesia (pethidine) Accepted for publication 15 June 1999 770 © 1999 BJU International