Comparison of ESWL and holmium laser lithotripsy

There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones.

Methods

Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm) were evaluated. All patients were followed up with ultrasonography for six months. The stone clearance rate, costs, and complications were compared.

Results

The similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesic requirement, and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive.

Conclusion

ESWL remains the first-line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. Determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.