Reanalysis of stone manipulation prior to extracorporeal shock wave lithotripsy for management of upper ureteral calculi

Background. In situ extracorporeal shock wave lithotripsy (ESWL) for upper ureteral stones is controversial, in contrast to ESWL treatment of the majority of other renal calculi. Some urologists recommend retrograde mobilization of the calculi into the renal pelvis prior to ESWL as a routine procedure, while others report little advantage in manipulating a ureteral stone into the kidney before treatment by ESWL. To better understand this controversial issue, we reanalyzed clinical studies and the mechanism of stone disintegration in ESWL. Methods. We performed a computerized MEDLINE search and manual bibliographic review of relevant peer reviewed reports from 1980 to 1998. Ten reports were analyzed with respect to stone-free rate and the important findings are summarized. Results. Two of 10 data sets are statistically significant (p < 0.05) to verify a higher stone-free rate and another five reports also revealed that higher stone-free rates could be expected with retrograde stone manipulation into the renal collecting system before treatment by ESWL. Conclusions. Higher stone-free rates with retrograde stone manipulation into the renal collecting system before treatment by ESWL is statistically significant and theoretically supported by the mechanism of stone disintegration.