Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Upper Ureteric Stones

This single‐centre, randomized, parallel‐group controlled trial was conducted in theDepartment of Urology, Federal Postgraduate Medical Institute, Shaikh Zayed Hospital,Lahore, Pakistan. The objective was to compare the treatment efficacy and short‐termsafety of extracorporeal shock wave lithotripsy (ESWL) with semirigid ureteroscopy (URS)in patients presenting with an upper ureteric stone.A total of 100 participants aged 18‐75 years were enrolled. Eligible participants had asingle unilateral upper ureteric stone located above the sacroiliac joint. The stone wasconfirmed on non‐contrast computed tomography of the kidneys, ureters and bladder,measured less than 10 mm in maximum diameter and had a density of 1000 Hounsfield unitsor less. Participants were randomized in a 1:1 ratio by lottery, with 50 participantsassigned to each treatment group.Participants assigned to ESWL were treated using the MODULITH SLX‐F2 lithotripter. Shockwaves were delivered at a rate of 60‐120 shocks per minute, with an energy setting of 1‐9kV and approximately 2500‐3000 shocks per session. Each session lasted approximately30‐60 minutes. A maximum of three sessions was permitted, with an interval of at least 48hours between successive sessions.Participants assigned to URS underwent semirigid ureteroscopy under general anesthesiausing a 6.5‐7.5 Fr semirigid ureteroscope. Stones were fragmented using the SwissLithoClast Master pneumatic lithotripsy system with a 1‐1.2 Fr probe. Stone fragmentswere removed using a Dormia basket or grasping forceps when required. A double‐J uretericstent was inserted in every participant undergoing URS and was subsequently removedaccording to clinical assessment.The primary outcome was complete stone clearance, assessed using non‐contrast computedtomography four weeks after completion of the assigned treatment. Complete stoneclearance was defined as the absence of any residual stone or stone fragment in theipsilateral kidney or ureter. A participant requiring an additional stone‐removalprocedure before the four‐week assessment was classified as having treatment failure.Secondary outcomes included the number of ESWL sessions required, pain relief, immediateprocedure‐related complications and complications occurring during the four‐weekfollow‐up period.