Management of simultaneous renal and ureteral calculi: combined extracorporeal shock wave lithotripsy and ureteroscopy under a single anesthetic.

Simultaneously occurring renal and ureteral calculi were treated in 28 renal units combining extracorporeal shock wave lithotripsy and ureteroscopy during a single anesthetic session. Distributions of ureteral calculi removed or attempted to be removed by ureteroscopy were upper third in 3, middle third in 4 and lower third in 21. If ureteroscopy was successful a ureteral stent was placed and extracorporeal shock wave lithotripsy was applied to more proximal renal and upper ureteral calculi. Of 28 renal units 25 (89%) were rendered free of stones or had passable calculi of less than 3 mm. in diameter after a single combined treatment. This combined approach appears to be safe, effective and efficient.