Treatment in the prone position of calculi in the midureter overlying the bony sacrum with extracorporeal shock wave lithotripsy.

Thirty-six patients with radiopaque calculi in the segment of the ureter overlying the sacrum, were treated in the prone position with an unmodified Dornier HM-3 lithotripter. Thirty-one treatments were successful and five failed for a success rate of 86%. Success is defined as the absence of fragments on KUB. The five failures were all removed ureteroscopically. Epidural anesthesia was used for all cases. A post-extracorporeal shock wave lithotripter (post-ESWL) gastrointestinal (GI) bleeding episode, and an upper ureteral extravasation post-ESWL, as well as two patients who could not tolerate the position are discussed.