Ureteroscopic management of a 12 mm upper ureteric stone is planned. The EAU guideline stone-free rate for ureteroscopy (URS) for proximal ureteric stones versus SWL (shock wave lithotripsy) shows:
- A URS achieves higher stone-free rates than SWL for stones >10 mm in the proximal ureter (∼80% vs ∼60%) ✓
- B SWL and URS have equivalent stone-free rates; SWL is preferred due to lower invasiveness
- C SWL is superior to URS for stones 10–20 mm in the proximal ureter based on RCT data
- D URS is contraindicated for proximal ureteric stones >10 mm due to risk of ureteric perforation
Correct answer: A. URS achieves higher stone-free rates than SWL for stones >10 mm in the proximal ureter (∼80% vs ∼60%)
Explanation
EAU guidelines note that for proximal ureteric stones >10 mm, ureteroscopy achieves stone-free rates of approximately 80–85% versus ~55–65% for SWL in meta-analyses, making URS the preferred modality for larger proximal stones. SWL is preferred for smaller (<10 mm) proximal ureteric stones due to its non-invasive nature. Semi-rigid or flexible URS with holmium laser lithotripsy is the standard URS technique for proximal stones.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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