Does ultrasound-guided ESWL improve stone-free rates for distal ureteral stones? A multicentric analysis.

PURPOSE: Shock wave lithotripsy (SWL) remains the main alternative to endoscopic surgery for distal ureteral stones. This study evaluated whether ultrasound (US)-guided SWL improves stone-free rates (SFR) compared with radiographic (RX) targeting. METHODS: We conducted a multicenter retrospective analysis of patients undergoing SWL for distal ureteral stones. Two cohorts were compared according to targeting modality (US-guided vs. RX-guided). Baseline characteristics, stone parameters, and procedural details were collected. SFR was assessed via US or CT scan at first follow-up and at 3 months. Multivariable logistic regression identified predictors of SFR. RESULTS: A total of 151 patients were included (77 US-guided, 74 RX-guided). Baseline demographic and stone characteristics were comparable between groups. US-guided SWL achieved significantly higher SFRs at first follow-up (76.7% vs. 44.6%, p < 0.001) and at 3 months (83.1% vs. 56.8%, p < 0.001). Stone size was the only independent predictor of SFR for both cohorts (US-group: OR 1.400 [95% CI 1.177-1.995], p = 0.011; RX-group: OR 1.487 [95% CI 1.434-2.227], p = 0.024). BMI and stone density were not associated with SFR. No severe complications occurred in either group. CONCLUSION: US-guided SWL for distal ureteral stones was associated with a higher SFR than RX-guided targeting. Stone size was the only independent predictor of treatment success. Further prospective studies are needed to validate these findings.