To evaluate the efficacy and the safety of transabdominal versus the transgluteal approach during extracorporeal shock wave lithotripsy (SWL) for distal ureteral calculi.
Material and methods
Retrospective analysis of 146 patients with a single distal ureteric stone, who underwent SWL in supine position, was performed. Stone dimensions, density, and the skin to stone distance (SSD) were obtained from preoperative computer tomography. In 76 cases, the procedure was performed using a transabdominal approach (Group 1). In 67 cases, SWL was performed via transgluteal approach, with shockwave source being placed below the patient (Group2). Stone-free rate (SFR), need for stenting, auxiliary procedures and complications rate was assessed for each group.
Demographic characteristics and stone features were similar in both groups. The mean stone size was 6.14 (3.4-11.2) mm in group 1 and 6.17 (3.1-15.8) mm in group 2. The skin to stone distance was 114.23 ± 26.83 mm and 103.84 ± 14.69 mm for Group 1 and Group 2 respectively (p=0.004). The SFR was 54% and 85% for transabdominal and transgluteal approaches, respectively. (p=0.0004). Ureteral stenting was performed in 16% of transabdominal and in 4% of transgluteal interventions (p=0.03). Auxiliary intervention was performed in 25% of group 1 patients and in 8% of group 2. The complication rate was 16% and 7% for transabdominal and transgluteal and approaches, respectively. No serious postoperative complications were observed.
Supine, transgluteal position SWL for the distal ureteral stone had a higher stone-free-rate, lower complications rate and lower need stenting for additional procedures.