The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study

Min Soo Choo, Jun Hyun Han, Jong Keun Kim, Tae Young Shin, Won Ki Lee, Sang Kon Lee, Seong Ho Lee

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Purpose: We compared the outcomes of SWL to treat distal ureter stones with regard to the conventional prone and supine positions using the transgluteal approach through the greater sciatic foramen. Methods: A prospective, randomized, single-blind, and multicenter study was conducted between October 2014 and July 2015. The inclusion criteria were radio-opaque distal ureter stones with a maximum diameter of 0.5−2 cm as measured on a CT scan. The included 160 patients were randomly assigned to two groups: the prone group (n = 80; treated in the conventional prone position) and the transgluteal group (n = 80; treated in the supine position using a transgluteal approach). In the latter group, the focused shock wave was transmitted through the greater sciatic foramen with the head positioned at a 40° angle to the vertical. “Stone-free” was defined as the complete clearance of stone fragments, assessed using a CT scan at 2 weeks after treatment. Overall satisfaction was self-reported using a 0–5 Likert scale. Results: The overall efficacy was 66.9%. The stone-free rate was significantly higher in the transgluteal group (72.6%) than in the prone group (54.7%; odds ratio 2.413, 95% CI 1.010−5.761, P = 0.023). No serious adverse events due to treatment were observed in either group. The satisfaction score of the transgluteal group was 4.21 ± 0.81, and 83.6% were willing to repeat the same procedure if necessary. Conclusions: SWL using the transgluteal approach via a supine position through the greater sciatic foramen was more effective than via the conventional prone position. Furthermore, this approach provided a comparably safe and satisfactory procedure.

Original languageEnglish
Pages (from-to)1299-1306
Number of pages8
JournalWorld Journal of Urology
Issue number8
StatePublished - 1 Aug 2018

Bibliographical note

Funding Information:
Funding This research was supported by Hallym University Research Fund 2015(HURF-2015-27).

Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Lithotripsy
  • Patient positioning
  • Prone position
  • Supine position
  • Treatment outcome
  • Ureteral calculi


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