Treatment Strategies of Ureteral Stones

Urinary stone disease is a major health care problem due to its high prevalence and incidence. There are different therapeutic approaches for ureteral stones depending on stone size, location and anatomical variations of the urogenital tract. Watchful waiting with concomitant medication (i.e., analgetics, anti-inflammatory agents, alpha-blockers) is considered an option for smaller stones (<6 mm) that have a high probability for spontaneous passage. Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic approach which has been widely used through the past 20 years. It is a standardized procedure which results in stone free rates between 59% and 100% depending on the size and the location of the stone as well as the type of the lithotriptor. However, more than one session are frequently needed and ureteral stenting is still a matter of debate. Ureteroscopy results in stone free rates of almost 95% in a single session. Stone removal may be achieved with forceps and baskets and with or without intraureteral stone disintegration with various lithotripsy devices. Treatment approaches should be individualized in order to achieve optimum outcomes.