TO COMPARE THE STONE FREE RATE AT ONE WEEK OF IN SITU EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) AND URETERORENOSCOPIC (URS) MANIPULATION IN THE TREATMENT OF PROXIMAL URETERIC STONE.

Objective: To compare the stone free rate at one week of in situ Extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation in the treatment of proximal ureteric stone.

Study Dsesign: Comparative cross-sectional.

Setting: Department of Urology & Nephrology Peoples University of Medical and Health Sciences (PUMHS), Nawabshah, Sindh.

Duration: Fourteen months from January 15, 2014 to March 15, 2015.

Material and methods: Study was conducted on a total number of 100 patients i.e. 50 patients in group A (dealt with extracorporeal shock wave lithotripsy) & 50 patients in group B (dealt with ureterorenoscopic manipulation). Extracorporeal shock wave lithotripsy (ESWL) was done under intravenous sedation as an outpatient procedure in supine position, and the electromagnetic lithotripter was used. Whereas, ureterorenoscopic (URS) manipulation was done under general anaesthesia, and an 8.0 Fr or 8.5 Fr semi rigid ureteroscope was used. A pneumatic (Swiss lithoclast) was used for intracorporeal lithotripsy.  The stone free rate were compared between the two groups by taking a look into clinical factor such as the size of stone at one week after the procedures.

Complication rate, success rate, re-treatment rate and auxiliary procedures were compared in each group.

Results: A total of 100 patients were treated for upper ureteric calculi, the stone free rate for in situ extracorporeal shock wave lithotripsy (ESWL) was 52% (26 of 50) patients, and for Ureterorenoscopic (URS) was 60% (30 of 50) patients (P=0.008). Whereas, the retreatment rate was significantly greater in ESWL group then in URS group (ESWL % v/s URS %). No major complications were encountered in both groups.

Conclusion: Despite the fact that extracorporeal shock wave lithotripsy (ESWL) is considered by many urologist as the 1^st line treatment for the proximal ureteric calculi, our study demonstrates that ureterorenoscopic manipulation (URS) with intracorporeal lithotripsy is a viable modality, and a safe alternative with an advantage of obtaining an early stone free status.

Keywords: Extracorporeal shock wave lithotripsy (ESWL), Ureterorenoscopic (URS), proximal ureteric stone.