الفهرس 
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Abstract
SUMMARY & CONCLUSION
he 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, active intervention is
often required for larger distal stones.
Ureteroscopic lithotripsy (URS) and extracorporeal
shock wave lithotripsy (ESWL) are principle therapies in distal
ureteral calculi treatment with satisfactory curative effect in the
vast majority of cases, and both have its own advantages and
disadvantages.
The reported advantages of ESWL include: less
invasiveness, short hospitalization, and a lower complication
rate. However, ESWL is not available in many centers and
often requires multiple treatment sessions. URS shares the
advantages of a more rapid stone clearance but often requires
anesthesia, longer hospitalization, and it is often associated
with a higher incidence of complications the choice between
ESWL and URS depends on multiple factors, Mainly 3 factors
are important for the selection of treatment modality which is
stone related factors, clinical factors and technical factors.
This study was performed at Ain Shams University
(Urology department) and El Doaah hospital (Urology
department), from August 2016 to August 2017, a total of 70
patients having solitary radiopaque large distal ureteral stone
T
Summary & Conclusion
144
ranges between 0.8-1.2 cm in diameter and ≥1.5 cm in length
were divided into two groups 35 patients each enrolled in our
prospective study.
All patients were subjected to preoperative evaluation in
the form of Full history taken, physical examination, laboratory
investigations
Patients of the first group were treated by URS plus
Trans-ureteral pneumatic lithotripsy (Swiss lithoclast) while
patients of the second group were treated with ESWL (Dornier
lithotripter S).
The aim of the present study was to compare the
efficacy, cost effect and safety of ESWL and URS for large
distal ureteric calculi by evaluating stone-free rates, retreatment
rates, need for auxiliary procedures, associated
complications and technical consideration with respect to
patient satisfaction.
The results of the study were:
In this study the overall stone free rate was considered
after two sessions of ESWL (in case of ESWL group) or two
trial of ureteroscopy (in case of URS group).
ESWL group: 9 case became stone free after the first
session, while the remaining 26 out of 35 patients needed second
session, 18 case became stone free after the second session.
Summary & Conclusion
145
ESWL failure occurred in 8 cases and they were
successfully managed by ureteroscopy
URS group: 32 case became stone free after first
ureteroscopy, while the remaining 3 patients needed second
ureteroscopy, 2 patient of them became stone free after second
ureteroscopy trial.
Ureteroscopy failure occurred in one patient due to
failure to diagnose ureteric orifice and successfully treated by
ureterolithotomy.
In ESWL group, patients were already at outpatient
clinic so there were no admission or hospital stay, all cases
done without anesthesia, just analgesic ± sedation
While in URS group patients admitted and the hospital
stay varies from one day to two days according to the condition
of the case, all URS cases had Spinal anesthesia
ESWL was shown to be less time consuming than URS
with a mean operative time of 46.09±4.38 minutes versus
60.29±12.60 minutes respectively.
In URS group there were 30 patients had ureteric
catheter inserted for 24 to 72 hours postoperatively and 5
patients had double (J) stent inserted for 4 weeks
postoperatively, while all the patients who underwent ESWL,
Summary & Conclusion
146
no auxiliary procedure done as this procedure is completely
non-invasive.
Among ESWL cases, No case had an intra-operative
complication, while URS group had 6 cases of intra-operative
complication.
There were 4 cases who had post-operative
complications among ESWL group, while there were 5 cases
who had post-operative complications among URS group.
ESWL was shown to be lower cost than URS with a
mean cost 2185.71 ± 110.86 LE versus 5514.29 ± 701.74 LE
respectively.
URS group showed higher satisfaction than ESWL group.