Holmium YAG Laser Ureterolithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Proximal Ureteric Stones; Prospective Randomized Study

Background: Shockwave Lithotripsy (SWL) and ureteroscopy using Holmium Laser are effective and minimally invasive procedures for treating proximal ureteric stones ≤ 1.5 cm. However, there is still a debate of which one is more suitable for the proximal ureteric stones. Different studies have reported a variety of outcomes of SWL and ureteroscopy, as the both treatments use advanced instruments, they offer few complications and good outcomes among urologists. Objective: To evaluate the safety and efficacy of ureteroscopy using Holmium YAG LASER for proximal ureteric stone ≤ 1.5cm compared to SWL. Patients and Methods: It was a randomized prospective trial comparing ureteroscopy with HO: YAG Laser to (SWL) in managing proximal ureteric stones, done in the period from April 2018 to April 2019. It included 40 patients with upper ureteral stones and were randomly divided into two groups: Group A: 20 patients treated by ESWL. Group B: 20 patients treated by ureteroscopy using LASER lithotripsy. Results: There was no significant difference between the two groups regarding patients and stones criteria as maximal diameter, HU and position opposite vertebrae, degree of hydronephrosis and overall success rate. Conclusion: ESWL and Ho-YAG laser lithotripsy are comparable in managing proximal ureteric stones in term of safety and efficacy. URS has the advantage of higher SFR from the first session and prolonged radiation exposure time. ESWL has the advantage of no need of anesthesia and no hospital stay as it was done as outpatient and this should be considered when counseling the patient with proximal ureteric stone.