Comparative Outcomes of Extracorporeal Shock Wave Lithotripsy, Pneumatic Lithotripsy, and Laparoscopic Ureterolithotomy in the Management of Large Proximal Ureteral Stones

Open Access

Abstract

Background: Large proximal ureteral stones are difficult to manage because of low spontaneous passage rates and reduced success with non-invasive treatments. ESWL, ureteroscopic pneumatic lithotripsy, and laparoscopic ureterolithotomy are commonly used modalities, but their comparative outcomes remain unclear. The aim of this study was to compare the effectiveness of ESWL, pneumatic ureteroscopic lithotripsy, and laparoscopic ureterolithotomy in patients with large proximal ureteral stones. Methods & Materials: This prospective observational study was conducted at Bangladesh Medical University, Dhaka, from July 2023 to June 2024. A total of 120 adult patients with proximal ureteral stones ≥10 mm was divided into three equal groups: ESWL (n = 40), pneumatic URS (n = 40), and laparoscopic ureterolithotomy (n = 40). Outcomes included stone-free rate, auxiliary procedures, complications, hospital stay, and recovery time. Results: Immediate stone-free rates were highest with laparoscopic ureterolithotomy (95%), followed by pneumatic URS (75%) and ESWL (55%) (p <0.001). At 3 months, stone-free rates were 100%, 85%, and 70%, respectively (p <0.001). ESWL required significantly more auxiliary procedures, while laparoscopic ureterolithotomy was associated with longer hospital stay and delayed recovery. Conclusion: Laparoscopic ureterolithotomy provides the highest definitive stone clearance for large proximal ureteral stones. Pneumatic lithotripsy offers a less invasive alternative with good effectiveness, while ESWL remains the least invasive option but with lower success rates.