Do upper ureteral stones need to be manipulated (push back) into the kidneys before extracorporeal shock wave lithotripsy?

The current practice for the management of upper ureteral stones is to push the stone back into the renal pelvis before extracorporeal shock wave lithotripsy (ESWL*). The results in 903 patients with an upper third ureteral stone pushed back before ESWL were compared to those of 815 with an upper third ureteral stone treated by ESWL in situ with a ureteral stent bypassing the stone. The stone size in the in situ group was larger than in the push back group. More shocks at a higher kilovoltage were required to treat the in situ group. The retreatment rate and post-ESWL secondary procedure rate for the push back group with single stones were 4% and 1.5%, respectively, compared to 5% and 7.5%, respectively, for the in situ group. The stone-free rate with single stones at 3 months was 73% in the push back group and 79% in the in situ group. There appears to be little advantage in manipulating a ureteral stone into the kidney (push back) before treatment by ESWL.