SWL literature
SWL Literature

Ito K. et al., 2020: Decreased Recurrence of Urolithiasis After Simultaneous Ureteroscopic Surgery for Ureter and Ipsilateral Renal Calculi: Comparison to Shockwave Lithotripsy for Ureter Calculi Alone

Ito K, Takahashi T, Kanno T, Okada T, Higashi Y, Yamada H.
Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.
Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.

Abstract
Objective: To compare follow-up outcomes of ureteroscopy (URS) and shockwave lithotripsy (SWL) for ureter calculi in the setting of asymptomatic renal calculi <15 mm.
Methods: This study included 789 patients who underwent URS (n = 301) or SWL (n = 488) as primary treatment for ureter calculi and who had ipsilateral renal calculi <15 mm between January 2012 and December 2019. For the URS group, all renal calculi were simultaneously treated unless contraindicated. One-to-one matching was performed using the propensity score (PS).
Results: After PS matching, analysis included 262 matched pairs of URS and SWL patients. The stone-free rate for ureter calculi without auxiliary procedure was 97.3% in the URS group and 93.9% in the SWL group. Any complication rates were 11.0% and 9.2% in the URS and SWL group, respectively; 1.1% of the URS patients experienced complications classified as Clavien-Dindo ≥IIIb. The estimated 2-year intervention-free survival was 88.1% in the URS group and 84.2% in the SWL group (P = 0.045). The estimated 2-year stone-event-free survival was 80.1% in the URS group and 71.0% in the SWL group (P = 0.009). Cox multivariate analysis showed that the hazard ratios of URS were 0.62 (P = 0.025) for surgical interventions and 0.64 (P = 0.008) for stone-related events after adjusting for baseline variables.
Conclusion: For patients with symptomatic ureter calculi and asymptomatic renal calculi <15 mm, URS with active treatment for renal calculi reduces future ipsilateral surgical intervention and stone-related events compared with SWL for ureter calculi.
Urology. 2020 Nov 10:S0090-4295(20)31351-0. doi: 10.1016/j.urology.2020.10.041. Online ahead of print. PMID: 33181120. FREE ARTICLE

 

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Kommentare 1

Hans-Göran Tiselius am Montag, 08. März 2021 08:30

At first glance this report appeared interesting in view of the risk of stone events following treatment of ureteral stones with URS or SWL. The informative value of the report is, however, deceased when it is understood that whereas the URS group had stones treated both in the ureter and the kidney, with SWL most patients had their stones successfully removed from the ureter only. In the SWL group stones in the kidneys were left un-treated. It had been interesting to see how the course of the disease in terms of probability score had developed after combined SWL of ureteral and kidney stones.
It is reassuring that in patients who were not treated with SWL for stones in the kidney as many as 71% were stone-event free during a follow-up period of 2 years.
Clinical stone events can occur following:
Passage of stones from the kidney.
Passage of stones after growth of clinically asymptomatic residual stones or fragments
Passage of NEW stones formed because of true recurrence.

Some results taken from the report.

https://www.storzmedical.com/images/blog/ItoKetal.JPG

Hans-Göran Tiselius

At first glance this report appeared interesting in view of the risk of stone events following treatment of ureteral stones with URS or SWL. The informative value of the report is, however, deceased when it is understood that whereas the URS group had stones treated both in the ureter and the kidney, with SWL most patients had their stones successfully removed from the ureter only. In the SWL group stones in the kidneys were left un-treated. It had been interesting to see how the course of the disease in terms of probability score had developed after combined SWL of ureteral and kidney stones. It is reassuring that in patients who were not treated with SWL for stones in the kidney as many as 71% were stone-event free during a follow-up period of 2 years. Clinical stone events can occur following: Passage of stones from the kidney. Passage of stones after growth of clinically asymptomatic residual stones or fragments Passage of NEW stones formed because of true recurrence. Some results taken from the report. [img]https://www.storzmedical.com/images/blog/ItoKetal.JPG[/img] Hans-Göran Tiselius
Gäste
Freitag, 17. September 2021

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