الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Urinary obstruction caused by an impacted stone is a serious problem as it may lead to progressive kidney dysfunction or severe complications, including pyonephrosis and sepsis. Stone impaction was thought to influence the success of fragmentation during ESWL
This fear has led many urologists to recommend ureteric stenting before ESWL to create an artificial chamber, with an improved stone-fluid interface, for better fragmentation during ESWL and to relieve the obstruction
Insertion of a ureteric stent is an invasive procedure, usually requiring general or regional anesthesia, thus increasing the risk and morbidity of the procedure, especially in elderly patients with associated multiple co-morbidities
Stent placement can also be technically difficult, particularly in an acute and completely obstructed system with the risk of ureteral perforation approaching 11% and failure rate approaching 20% even in the presence of well-trained urologists.An additional procedure will be required for stent removal adding to the cost and risk of complications
In patients with impacted ureteral stones undergoing urgent in situ ESWL, urine is present in the ureter above the stone, and there are no associated factors that may diminish the efficacy of shock wave energy
ESWL is an efficient and safe treatment for > 10 mm ureteral stones. Pre-treatment stenting isthought limit stone-free rates and is significantly influencing post ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.