• Hazim R. Akal Assistant professor, Dept. of surgery, Medical college, Thiqar university


Purpose: To evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of upper ureteral stones. Patients and methods Between May 2009 and  June  2011, 115 patients with radio-opaque upper ureteral stones who referred to lithotripsy unit in Al-hussain teaching hospital in Thiqar, 83 male( average 48 years) and 32 female (average 51years), treated with extracorporeal shock wave lithotripsy (ESWL). The patients were discharged from the hospital on the same day of treatment and patients were asked to return after two weeks for fallow up plain film together with ultrasound examination, to be able to detect fragmentation and stone clearance together with the effect of treatment and obstruction on the upper tract. Results The over all success rate for the patient at 3 months of follow up was 64.3% (74 pt.)  the success rate decreases as the stone size increases. It decrease from 76% to patients with stone <10 mm to only 52% to patients with stone > 15mm. The remaining 41 patients (35.6%) were considered failure, either due to non fragmentation of the stone despite repeated sessions (3 sessions) or fragments are large that failed to pass (5 cases). All patients were treated on an outpatient basis; the complications were minimal and treated conservatively. Conclusions ESWL is safe, effective, noninvasive and a convenient way of treatment for upper ureteral stones.  ESWL being an outpatient procedure without any need for anesthesia or any pretreatment intervention, it should be considered as the first line of treatment for all stones in the upper ureter. However the clearance rates for stones larger than 15 mm were low.


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