Management of proximal ureteral stones

Proximal ureteral stone less than 4-6 mm may initially be treated by surveillance. Generally, extracorporeal shockwave lithotripsy (ESWL) is the first Line treatment for proximal ureteral stones, specially for stones less than 1cm. For stones greater than 1cm, the results of ureteroscopy (URS) are better than the results of ESWL and in these cases URS may be an option. In case of failure of ESWL, URS can be proposed. URS can be the first tine treatment in case of severe ureteral obstruction with no urinary infection. Proximal ureteroscopy must be careful because severe complications are not infrequent. Open surgery has very rare indication. Metabolic check-up and annually follow-up with at least a renal imaging at three months are recommended. (c) 2008 Elsevier Masson SAS.