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Cui Y et al, 2014: Comparison of ESWL and Ureteroscopic Holmium Laser lithotripsy in Management of Ureteral Stones

Cui Y, Cao W, Shen H, Xie J, Adams TS, Zhang Y, Shao Q
Department of Urology, Suzhou Municipal Hospital, Suzhou, China
Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America


Abstract

BACKGROUND: There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones.

OBJECTIVE: To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones.

METHODS: Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared.

RESULTS: Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive.

CONCLUSION: ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

PLoS One. 2014 Feb 3;9(2):e87634. doi: 10.1371/journal.pone.0087634. eCollection 2014.
PMID:24498344[PubMed - in process]
PMCID:PMC3912003

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Comments 1

Peter Alken on Wednesday, 19 February 2014 14:10

A retrospective but interesting paper that offers slightly different aspects than the currently popular views on an old theme: The procedural time difference – outpatient vs hospitalized patients - resulted in a cost difference of 120±25 US$ for SWL vs.1180±258US$ for URS.

Peter Alken

A retrospective but interesting paper that offers slightly different aspects than the currently popular views on an old theme: The procedural time difference – outpatient vs hospitalized patients - resulted in a cost difference of 120±25 US$ for SWL vs.1180±258US$ for URS. Peter Alken
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