Extracorporeal Shock Wave Lithotripsy in Impacted Upper Ureteral Stones: A Prospective Randomized Comparison Between Stented and Non-stented Techniques

Objectives To assess the need for pre-extracorporeal shock wave lithotripsy (pre-ESWL) stenting in management of impacted upper ureteral stones of size ≤ 2 cm and to verify whether stenting would influence the success of therapy. Methods Between 2007 and 2008, a total of 60 patients with solitary, radio-opaque impacted upper ureteral stones measuring ≤ 2 cm were divided into 2 equal groups: a stented group with a Double-J stent fixed pre-ESWL and a non-stented group treated by in situ ESWL. All patients were treated by ESWL using Dornier Doli S lithotripter. Results were compared in terms of clearance rates, number of shock waves and sessions, morbidity, and incidence of complications. Pretreatment KUB (kidneys, ureters, and bladder) and intravenous pyelogram and post-treatment KUB were used to evaluate fragmentation and clearance. Results Overall stone-free rate was 88.3%. No significant statistical difference was observed in stone-free rate between the stented and non-stented groups being 90% and 86.7%, respectively ( P = .346). One session was required in 28.3% of patients, whereas multiple sessions were required in 71.7% of patients. No significant statistical difference was noted in re-treatment rate in the 2 groups. Patients in the stented group significantly complained of side effects attributable to the stent predominantly dysuria, urgency, frequency, and suprapubic pain. Conclusions ESWL is an effective and reasonable initial therapy in the management of impacted upper ureteral stones measuring ≤ 2 cm. Pre-ESWL ureteral stenting provides no additional benefit over in situ ESWL. Moreover, ureteral stents are associated with significant patient discomfort and morbidity.