A study by surgeons at University Federico II in Italy has recommended that extracorporeal shockwave lithotripsy (ESWL) is used to remove smaller kidney stones trapped in the distal ureter.

The same study recommended that uretoscopy should be used to remove larger stones.

The surgeons conducted a prospective randomised study designed to compare the two procedures. It involved 273 patients with single distal ureteric stones ranging from 0.5cm to 1.5cm.

The results indicated that ESWL patients with stones 1cm or less had fewer complications than patients with stones larger than 1cm (7% versus 28%).

Stone free status for EWSL patients was 96% for stones less than 1cm and for 90% for larger stones.

In addition, ESWL patients with smaller stones required fewer re-treatments (12% versus 80%) and auxiliary procedures (3% versus 20%).

URS patients had similar stone-free rates for in both groups, but re-treatment was higher in patients with stones over 1cm.

URS patients with stones exceeding 1cm, however, had fewer complications (14% versus 24%) when compared to those with stones less than 1cm, and they required fewer auxiliary procedures (12% versus 25%).

Study author, Professor Vincenzo Mirone said the results clearly indicate that ESWL should be the first choice for patients with stones of 1cm and under and URS should be the first choice for patients with stones exceeding 1cm.