Comparison of Treatment Efficacy of Extracorporeal Shock Wave Lithotripsy Verses Ureteroscopy in Patients Presenting with Upper Ureteric Stone: A Randomized Controlled Trial.

Abstract

Objective: Upper ureteric stones cause pain, hematuria, obstruction, and renal complications. Extracorporeal shock-wave lithotripsy (ESWL) is non-invasive but may require repeated sessions. Ureteroscopy (URS) permits direct stone fragmentation and removal. To compare the treatment efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) in patients with upper ureteric stones.
Methodology: This comparative study included 100 patients from 01 December 2025 to 01 June 2026 aged 18–75 years with a single upper ureteric stone smaller than 10 mm and density not exceeding 1000 Hounsfield units. Patients were allocated by lottery into ESWL and URS groups, with 50 patients in each group. ESWL was performed with a MODULITH SLX-F2 lithotripter for up to three sessions. URS was performed under general anesthesia using a semirigid ureteroscope and pneumatic lithotripsy. Stone clearance was assessed by non-contrast computed tomography after four weeks. Data were analyzed using IBM SPSS Statistics version 21.
Results: Complete stone clearance at four weeks occurred in 40 of 50 patients (80.0%) after ESWL and 47 of 50 pa-tients (94.0%) after URS (p=0.037). Treatment failure occurred in 20.0% and 6.0% of patients, respectively. Immediate procedural complications occurred in 4.0% of the ESWL group and 6.0% of the URS group. Post-treatment complica-tions occurred in 18.0% and 20.0% of patients, respectively (p=0.799).
Conclusion: URS achieved a higher four-week stone-clearance rate than ESWL. Both treatments had comparable short-term complication rates.
Keywords: Extracorporeal shock-wave lithotripsy,Hounsfield unit, Stone clearance, Upper ureteric stone, Ureteroscopy.