COMPARISON OF STONE FREE RATE BETWEEN EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND URETEROSCOPIC LASERTRIPSY IN THE MANAGEMENT OF PROXIMAL URETERAL STONES

Background: Proximal ureteric stones are a common urological condition, affecting up to 12% of the population. While smaller stones may pass spontaneously, larger stones often require active intervention to prevent complications such as obstruction and renal impairment. Treatment options have evolved from invasive surgeries to less invasive modalities like extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic lasertripsy (URS laser). Selecting the optimal modality is critical for maximizing stone clearance and minimizing complications. Objective: To compare the stone-free rates and clinical outcomes of ESWL and URS laser in the management of proximal ureteral stones. Methods: This randomized controlled trial was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar, from September 2024 to February 2025. A total of 166 patients diagnosed with proximal ureteric stones on non-contrast CT KUB were enrolled and equally divided into two groups. Group A (n=83) underwent ESWL using the Storz Modulith SLX-F2 lithotripter, while Group B (n=83) received URS laser using a semi-rigid ureteroscope with Holmium:YAG laser lithotripsy. Data were recorded using a structured proforma and analyzed with SPSS version 23. Stone-free status was assessed by CT KUB one month post-treatment. Results: The mean age was 39.18 ± 11.95 years in Group A and 39.19 ± 11.24 years in Group B (p = 0.339). The stone-free rate was significantly higher in Group B (92.8%, n=77) compared to Group A (47%, n=39) (p = 0.001). The overall complication rate was 26.5% in Group A and 37.3% in Group B (p = 0.008). Re-treatment was required in 48.2% (n=40) of Group A patients and 7.2% (n=6) in Group B (p = 0.001). No ureteral perforations were reported in either group. Conclusion: URS laser provides a significantly higher stone-free rate and lower need for re-treatment compared to ESWL in the management of proximal ureteric stones, supporting its use as a preferred treatment option.