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Introduction: It was the aim of this study to compare the efficiency and safety between shock wave lithotripsy (SWL) and ureteroscopic holmium laser lithotripsy (URL) methods for ureteral calculi while also determining which option is more cost-effective. Patients and Methods: During January 2008 to September 2009, a prospective randomized study was conducted to compare both modalities for the management of solitary radiopaque ureteral stones. Patient and stone characteristics, treatment outcome and charges were documented. Both options were compared using univariate statistical tests to identify the efficiency quotient and cost-effectiveness for ureteral calculi according to the stone location. Results: A total of 257 patients were in the SWL group, while 269 were in the URL group. The efficiency quotients for SWL and URL were 0.81 and 0.88, respectively. The initial stone-free rate of URL for lower ureteral calculi was higher (p = 0.002), while the complication rate of SWL for upper ureteral calculi was lower (p = 0.027). The SWL group required lower hospitalization charges (USD 440 vs. 1,221; p < 0.001), lower total charges (USD 454 vs. 1,284; p < 0.001) and a shorter period of hospitalization (5.4 vs. 6.6 days; p < 0.001) compared with the URL group for all ureteral locations. For mid and lower ureteral calculi, the postoperative office visits of the URL group were fewer (1.03 vs. 1.1 times; p = 0.001). Conclusions: Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China. However, primary URL was a better option for treating lower ureteral stones with a higher stone-free rate but was more expensive. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Urolithiasis is a common urologic disease whose prevalence is about 1–20% and increasing throughout the world. The recurrence rate after treatment is more than 50%. Urinary stone analysis is important in determining the possible etiology and the pathophysiology of stone formation. A better understanding of the stone composition may help prevent urinary stone formation. From March 2007 to December 2008, physical analysis of urolithiasis in patients who lived in eastern China for more than 5 years and underwent surgery or shock wave lithotripsy in our hospital or passed their stones spontaneously was carried out using the Fourier transform infrared spectroscopy (FT-IR). Clinical and demographic findings were evaluated and compared with the stone components. Stone analysis was performed in 625 patients. The FT-IR evaluation showed that 234 (37.4%) were pure, and the most frequent was calcium oxalate (33.9%), followed by calcium phosphate (2.7%), and uric acid (0.8%). 391 (62.6%) were mixed stone, calcium oxalate (43.2%) was the most commonly major component, followed by calcium phosphate (16.3%), cystine (1.3%), uric acid (1.1%), and struvite (0.6%). Uric acid ( p = 0.029) was the major component found more frequently in men, while struvite ( p = 0.037) was more frequent in women. Uric acid ( p = 0.031) was more common in lower urinary tract stones, and its formers with the mean age of 55 years were older than those with other components ( p = 0.039). In eastern China, the most commonly found pure stone was calcium oxalate, while the most frequent mixed stone was calcium oxalate and calcium phosphate mixture. Stone location, gender, and age may influence stone component. [ABSTRACT FROM AUTHOR]