***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To compare the success , efficacy and complications of ureteroscopy ( URS ) and extra corporeal shock wave lithotripsy ( ESWL ) for the treatment of symptomatic small non obstructing lower ureteric calculi . SUBJECTS AND METHODS This prospect i ve non-r and omised study was conducted simultaneously at two urological referral centres , included 280 patients with symptomatic small ( 4 - 10 mm ) lower ureteric calculi ( situated below the sacroiliac joint ) , with good renal function on intravenous urography . Patients were offered both the treatment options . One hundred and sixty patients chose ureteroscopy  , whereas 120 patients were treated by  ESWL . St and ard techniques of ureteroscopy and ESWL were employed . Patients were followed-up to assess the success rates and complications of the two procedures . RESULTS Ureteroscopy achieved complete stone clearance in one session in 95 % of patients . In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7 % . Two patients had a proximal migration of calculus that needed ESWL . Of the 120 patients treated by ESWL , 90 % achieved stone free status at three months . Ureteroscopy was needed for twelve patients ( 10 % ) where ESWL failed to achieve stone clearance . There were no significant ESWL related complications . ESWL was administered on outpatient basis , while patients needed hospitalisation and anaesthesia for ureteroscopy . CONCLUSION ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe . Ureteroscopy can be offered to patients who dem and immediate relief or when ESWL fails PURPOSE We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi . MATERIAL S AND METHODS A total of 64 patients with solitary , radiopaque distal ureteral calculi 15 mm . or less in largest diameter were r and omized to treatment with shock wave lithotripsy ( 32 )  using an HM3 lithotriptor ( Dornier MedTech , Kennesaw , Georgia ) or ureteroscopy ( 32 ) . Patient and stone characteristics , treatment parameters , clinical outcomes , patient satisfaction and cost were assessed for each group . RESULTS The 2 groups were comparable in regard to patient age , sex , body mass index , stone size , degree of hydronephrosis and time to treatment . Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group ( 34 and 72 versus 65 and 97 minutes , respectively ) . In addition , 94 % of patients who underwent shock wave lithotripsy versus 75 % who underwent ureteroscopy were discharged home the day of procedure . At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy , respectively , 91 % of patients in each group had undergone imaging with a plain abdominal radiograph , and all studies showed resolution of the target stone . Minor complications occurred in 9 % and 25 % of the shock wave lithotripsy and ureteroscopy groups , respectively ( p value was not significant ) . No ureteral perforation or stricture occurred in the ureteroscopy group . Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group , although the differences were not statistically significant . Patient satisfaction was high , including 94 % for shock wave lithotripsy and 87 % for ureteroscopy ( p value not significant ) . Cost favored ureteroscopy by $ 1,255 if outpatient treatment for both modalities was assumed . CONCLUSIONS Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates . However , shock wave lithotripsy required significantly less operating time , was more often performed on an outpatient basis , and showed a trend towards less flank pain and dysuria , fewer complications and quicker convalescence . Patient satisfaction was uniformly high in both groups . Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones , we believe that HM3 shock wave lithotripsy , albeit slightly more costly , is preferable to manipulation with ureteroscopy since it is equally efficacious , more efficient and less morbid PURPOSE In an effort to streamline a comparison of the effectiveness of a new lithotriptor with the st and ard HM3 lithotriptor ( Dornier Medical Systems , Inc. , Marietta , Georgia ) we used a matched pair analysis design . A matched design often provides more efficient estimates ( smaller variances ) than an unmatched design given the same sample size . MATERIAL S AND METHODS Patients with solitary renal or ureteral calculi treated on a LithoTron shock wave lithotriptor ( HealthTronics , Marietta , Georgia ) between October 1999 and February 2000 with a minimum followup of 3 months were identified . Evaluable patients treated with the LithoTron  were matched using 5 parameters to a data base of patients treated with an unmodified HM3 shock wave lithotriptor between October 1997 and February 2000 . Matching criteria consisted of calculus side , calculus location ( 1 of 7 categories ) , maximum stone diameter ( + /-2 mm . ) , minimum stone diameter ( + /-2 mm . ) and patient body mass index ( BMI + /-6 ) . When more than 1 match was suitable , matching was directed by r and om numbers . Following matching , clinical charts and radiographic reports were evaluated for stone clearance and post-shock wave lithotripsy interventions . Stone treatment success was defined as residual fragments less than 2 mm . without need for further intervention . RESULTS A total of 94 potentially evaluable patients treated with the LithoTron  were identified and 38 matched pairs were created . Average maximum stone diameter , minimum stone diameter , and BMI were 9.6 and 9.9 mm . , 6.7 and 6.8 mm . and 29.3 and 28.9 kg./m . for HM3 and LithoTron cases , respectively . All calculi were radiopaque and consisted of mixed calcium oxalate monohydrate ( 19 and 13 ) , calcium oxalate dihydrate ( 1 and 1 ) or calcium phosphate ( 2 and 2 ) in the HM3 and LithoTron groups , respectively . Patients were not specifically matched on stone composition because of incomplete availability . Overall intervention-free , stone treatment success rate was 79 % for the HM3 and 58 % for the LithoTron . OR for failure of LithoTron versus HM3 treatment was 3.004 ( McNemar test p = 0.08 ) . There were 16 discordant pairs . In 4 cases LithoTron was successful and HM3 failed , and in 12 cases LithoTron failed and HM3 was successful . Subgroup analysis revealed a trend for LithoTron treatment failure for lower pole calculi , calculi 10 mm . or greater and BMI of 30 kg./m . or greater . CONCLUSIONS In this initial evaluation the HM3 , despite a relatively small study sample size , appeared to provide superior clinical results to the LithoTron ( p = 0.08 ) . The use of matched pair analysis using a large cohort of patients treated with the HM3 for retrospective matching may allow for accurate determination of the effectiveness of new lithotripsy technology with a relatively small clinical study group BACKGROUND To establish the best treatment modality in our hospitals for patients with proximal-ureteral calculi 5 to 10 mm , we compared the treatment outcome in those who underwent  primary ureteroscopy ( URS )  with that in patients who underwent primary in-situ SWL . The primary endpoints were stone-free rates at 3 weeks and 3 months and the subjective patient experience . PATIENTS AND METHODS The study was a prospect i ve patient-preference trial . From September 2002 to May 2005 , 80 patients were included , of whom 71 could be evaluated . Thirty-three patients were treated with SWL and 38 with semirigid or flexible URS .  Stone status was evaluated with excretory urography or noncontrast helical CT . The bother score of urinary-tract symptoms was recorded on a visual analog scale . RESULTS The stone-free rate at 3 weeks was 58 % and 78 % ( P = 0.061 ) and at 3 months 88 % and 89 % ( P = 1 ) for SWL and URS , respectively . The percentage of patients in need of analgesics was 30 % and 49 % ( P = 0.118 ) at 3 weeks and 9 % and 21 % ( P = 0.181 ) at 3 months for the SWL and the URS group , respectively . The bother score regarding dysuria , hematuria , and flank pain were statistically significant in favor of SWL . CONCLUSION Ureteroscopy tends to make patients stone free faster , but SWL is preferred by most patients because there is less discomfort after treatment OBJECTIVES To conduct a prospect i ve and r and omized trial to compare the efficiency quotient and cost-effectiveness index of shock wave lithotripsy ( SWL ) and ureteroscopic lithotripsy ( URSL ) for the treatment of large upper third ureteral stones . METHODS A total of 35 male patients and 7 female patients with a solitary , radiopaque upper ureteral stone , 15 mm or more in diameter , who underwent SWL or URSL were enrolled in this study . The mean patient age was 53.1 + /- 14.5 years . The endpoint of the study was for the patient to be stone free or to have insignificant residual stone ( 3 mm or less ) within the kidney . RESULTS The mean stone length + /- SD was 17.9 + /- 3.9 cm in the SWL group and 18.5 + /- 2.9 cm in the URSL group ( P > 0.05 ) . The efficiency quotient for SWL and URSL was 0.61 and 0.63 , respectively . The cost-effectiveness index , treatment time , pain score , and hospital stay were greater in the URSL group . However , the degree of hydronephrosis significantly influenced the success rate of SWL . All patients with severe hydronephrosis in the SWL group needed auxiliary surgical procedures to become stone free . CONCLUSIONS The efficiency quotients of SWL and URSL were comparable in the treatment of large upper third ureteral stones . However , SWL should not be recommended as the first-line treatment option for the management of upper third ureteral stones larger than 1.5 cm with severe hydronephrosis . Underst and ing the cost-effectiveness , success rate , pain score , and patient satisfaction score for the two different approaches constitutes the indispensable requisites for choosing the optimal first-line therapeutic strategy The treatment of proximal ureteral calculi has been altered markedly by recent developments in shock wave lithotripsy ( bypass , pushback and in situ ) , ureterorenoscopy and percutaneous stone removal . In an effort to discern the proper role of these newer treatment options with respect to ureterolithotomy ( flank approach or dorsal lumbotomy ) , we completed a multicentered study in which 142 upper ureteral stone patients in 7 different treatment categories were review ed retrospectively and contacted for convalescence data . From these data we conclude that before extracorporeal shock wave lithotripsy an upper ureteral stone should be manipulated until it is either pushed back to the kidney or bypassed with a stent . This maneuver should result in successful extracorporeal shock wave lithotripsy in more than 90 per cent of the patients . For those few patients with an impacted upper ureteral calculus ureterorenoscopy is recommended . Given the presently available treatment modalities we conclude that less than 3 per cent of all upper ureteral calculi will require ureterolithotomy . In this last circumstance a dorsal lumbotomy incision appears to be less morbid and yet as effective as anterior ureterolithotomy OBJECTIVES To evaluate whether alpha1-blockers have any impact on stone clearance in patients with lower ureteral stones who underwent either shock wave lithotripsy ( SWL ) or were followed up with st and ard hydration , analgesics , and anti-inflammatory treatment . METHODS A total of 78 patients ( 56 men and 22 women ) who had lower ureteral stones located at the distal 5 cm of the ureter were divided into four groups . The first group consisted of 30 patients ( 38.5 % ) with stones less than 5 mm ( range 3 to 5 ) who were r and omly divided into two subgroups . Group 1 consisted of 15 patients ( 19.2 % ) who were followed up with oral hydration and diclofenac sodium . Group 2 consisted of 15 patients ( 19.2 % ) who received tamsulosin 0.4 mg daily in addition to the st and ard regimens . The second two groups consisted of 48 patients ( 61.5 % ) with stones greater than 5 mm ( range 6 to 15 ) who underwent SWL . These patients were also r and omly divided between those who did not ( group 3 , n = 24 ) and those who did ( group 4 , n = 24 ) receive tamsulosin 0.4 mg daily . All patients were re-evaluated with plain abdominal x-rays and helical computed tomography 15 days after the beginning of treatment . RESULTS Of the 78 
    Output:
    
Compared with ESWL , ureteroscopic removal of ureteral stones achieves a greater stone-free state , but with a higher complication rate and longer hospital stay