Extracorporeal shockwave lithotripsy vs ureteroscopy as first-line therapy for patients with single, distal ureteric stones: a prospective randomized study.

The distal ureter is the location of the great majority of ureteric stones . Stones with a diameter of < 5 mm have a high chance of spontaneous expulsion ranging from 71% to 98% [2]. By contrast, active intervention is often required for distal stones of > 5 mm [2]. To date, open surgery is still required in a few patients, while extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) have emerged as valid, minimally invasive alternatives for the treatment of distal ureteric stones [3]. However, the best first-line treatment remains a controversial issue. The reported advantages of ESWL include: less invasiveness, short hospitalization, and a lower complication rate. However, ESWL is not available in many centres and often requires multiple treatment sessions. URS shares the advantages of a more rapid stone clearance but often requires anaesthesia, longer hospitalization, and it is often associated with a higher incidence of complications [4]. In recent years, the development of new generation lithotripters using electromagnetic energy has increased the efficacy of ESWL for the treatment of ureteric stones located in the mid and distal ureter without the need for any type of anaesthesia [5]. On the other hand, the development of new endoscopic techniques has led some authors to consider URS a more appropriate first-line treatment for distal ureteric stones, mainly due to its cost-effective benefits [6]. Consequently, the choice between ESWL and URS depends on multiple factors, e.g. the number of treatments required to obtain a stone-free status, the duration of the hospital stay, the need for anaesthesia and for auxiliary procedures, the experience and equipment of the centre. The aim of the present study was to compare ESWL and URS as first-line treatments for patients with solitary, monolateral, distal ureteric stones.