Although
extracorporeal shockwave lithotripsy (SWL) is a successful treatment for
ureteral calculi, introduction of miniureteroscopes has advanced endoscopic management. We combined the use of a semirigid
ureteroscope with a pneumatic lithotripter (Swiss Lithoclast) for the treatment of
ureteral calculi. From January 1992 to August 1994, 143 patients (87 male, 56 female; mean age 48.7 years; age range 22-74 years) with
urolithiasis underwent endoscopic
lithotripsy with the Swiss Lithoclast under
general anesthesia. The 0.8 = mm probe was inserted through the deflected working channel (3.4F) of the Micro-6L
ureteroscope (tip diameter 6.9F). The
calculi were in the distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N = 13; 9.1%) of the ureter. The mean stone size was 6.8 mm (range 5-26 mm). Of the 137 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual fragments <3 mm that passed spontaneously. The remaining 36 patients underwent another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic
lithotripsies in 14 (10.2%), and open surgery in 3. Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effective for endoscopic
lithotripsy, regardless of stone composition. Deflection of the probe up to 30 degrees did not impair the disintegration rate. Because of the high migration rate of mid and proximal ureteral stones, the Swiss Lithoclast is not recommended in these cases as a primary procedure. Low capital cost and simple and safe handling are the device's major advantages over
laser lithotripsy.