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Hrbáček J, 2014: URS versus ESWL: another contribution to the never-ending debate.

Hrbáček J
Department of Urology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.

Abstract

No abstract available.

Cent European J Urol. 2014;66(4):463-4. doi: 10.5173/ceju.2013.04.art20.

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Hans-Göran Tiselius on Tuesday, 26 August 2014 11:25

As in numerous other studies the author emphasizes and discusses the advantage of endoscopic procedures over SWL for active removal of ureteral stones. It is for instance mentioned that re-treatment rates were necessary in 45% of patients treated with SWL in comparison with 8% in case of URS. The interpretation by the author accordingly was that every other patients treated with SWL required a re-treatment. This conclusion is, however, for most patients certainly not correct, because the re-treatments are usually restricted to a much smaller group of patients with particularly problematic stones, for which more than two sessions might have been necessary. In my own experience in a group of unselected patients with ureteral stones, 73 % with stones in the proximal, 67 % in the mid and 83 % in the distal ureter had their stones satisfactorily disintegrated with only ONE session [1].

Like in so many other reports, the advantages of non-invasive stone removal is not fully appreciated for its absence of anaesthesia, low risk of complications and the possibility to complete the treatment as an out-patient procedure. But fortunately the bottom-line of the present report was that the choice between SWL and URS could be left to the decision by the patients.

Reference
Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol. 2008 22:249-255

As in numerous other studies the author emphasizes and discusses the advantage of endoscopic procedures over SWL for active removal of ureteral stones. It is for instance mentioned that re-treatment rates were necessary in 45% of patients treated with SWL in comparison with 8% in case of URS. The interpretation by the author accordingly was that every other patients treated with SWL required a re-treatment. This conclusion is, however, for most patients certainly not correct, because the re-treatments are usually restricted to a much smaller group of patients with particularly problematic stones, for which more than two sessions might have been necessary. In my own experience in a group of unselected patients with ureteral stones, 73 % with stones in the proximal, 67 % in the mid and 83 % in the distal ureter had their stones satisfactorily disintegrated with only ONE session [1]. Like in so many other reports, the advantages of non-invasive stone removal is not fully appreciated for its absence of anaesthesia, low risk of complications and the possibility to complete the treatment as an out-patient procedure. But fortunately the bottom-line of the present report was that the choice between SWL and URS could be left to the decision by the patients. Reference Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol. 2008 22:249-255
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