Extra-Corporeal Shock Wave Lithotriposy ( ESWL ) for Lower Ureteral Stone

Background: The optimal treatment of ureteral stones, particularly the lower ureteral stone, still controversial[5,13,15,18]. Objective: To assess the success rate of ESWL and tamsulosin in lower ureteral stone. Also to identify the parameters that affects the success rate of ESWL in the lower ureteral stone. Patients and Methods: Prospective study has been done on thirty-six patients sequentially selected from referred cases to the ESWL department in Sulaimania Teaching Hospital in the period from June, 2010 to January, 2011). All had radioopaque lower ureteric stone (from the lower border of sacroiliac joint to uretero-vesical junction). Stones ranging from (5.8 to14mm), twenty in the left side and sixteen in the right side , age ranging from (10 to 78 years), and only four of them had double J-stent (within 1 week before ESWL). Weekly follow up of all patients were done by U/S and twice-weekly by KUB for 6 weeks. Results: Twenty four cases (66.7%) were free of stone, five cases (13.9%) had residual stone and seven cases (19.4%) failed to respond, the most important two parameters that affect the result are the size of stone and number of sessions. Conclusion: ESWL is safe and useful, and it is considered to be the first favorable line of intervention for lower ureteric stones after failure of watchful waiting and medical expulsion therapy especially those without complications like obstruction. Keywords: Lower ureteric stone, extracorporeal shock wave lithotripsy