Treatment of ureteral calculi with ballistic lithotripsy.

Objective: Ballistic lithotripsy is one of the new intracorporeal lithotripsy methods. In this study, the efficacy and complications of this method in the management of ureteral calculi were evaluated.

Methods: From November 1999 to December 2001, 340 patients (mean age 39.8 years; range 1.5-82 years) with a total of 362 ureteral calculi (bilateral in 22 cases) were treated with an 8.5F rigid ureteroscope and the Swiss Lithoclast. Of the calculi, 115 (32%) were located in the upper ureter, 63 (17%) in the middle ureter, and 184 (51%) in the lower ureter. The mean stone size was 10.4 mm (range 5-22 mm).

Results: Nearly all (344; 95%) of the calculi were accessible with the ureteroscope, and 321 calculi (88.7%) were fragmented completely, either with no residual fragments or with residual fragments <3 mm. In 3 cases (0.8%), there were residual fragments of about 4 mm after the procedure that passed spontaneously. Twenty calculi (5.5%) migrated to the kidney during the procedure and were subsequently treated with adjuvant SWL. Major complications occurred in 2 cases (0.54%): ureteral perforation and stenosis in 1 patient each. The 2-week stone-free rate was 89.5% (324/362).

Conclusions: Lithoclast ballistic lithotripsy is a safe and effective approach for the treatment of ureteral calculi regardless of composition.