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Sener NC et al, 2013: Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm

Sener NC, Abdurrahim Imamoglu M, Bas O, Ozturk U, Goksel Goktug HN, Tuygun C, Bakirtas H
Department of Urology, Numune Education and Research Hospital, Ministry of Health, Adana, Turkey


Abstract

In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.

Urolithiasis. 2013 Nov 13. [Epub ahead of print]
PMID:24220692 [PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Friday, 29 November 2013 09:21

This report is one of many that demonstrate a better outcome of flexible URS than of SWL when stones in the lower calyx are treated. Unfortunately I have a feeling that the urologists´ enthusiasm for endoscopic procedures might have affected the outcome. Re-treatment rates of 2.7 for stones with a mean diameter of 8 mm are unexpected. Appropriate application of shockwaves should result in a better stone disintegration than that. So, either is the lithotripter not working as it should or is the technique of SWL inferior. It would be desirable to compare the results of stone disintegration following URS with that following carefully conducted SWL, in contrast to what appears to be routinely performed lithotripsy according to standardized protocol.

Although it is well recognized that more residuals will be found after SWL than after URS, the question is if the invasive procedure is worth the efforts and also how aggressively minor non-infection stone fragments should be treated.

Hans-Göran Tiselius

This report is one of many that demonstrate a better outcome of flexible URS than of SWL when stones in the lower calyx are treated. Unfortunately I have a feeling that the urologists´ enthusiasm for endoscopic procedures might have affected the outcome. Re-treatment rates of 2.7 for stones with a mean diameter of 8 mm are unexpected. Appropriate application of shockwaves should result in a better stone disintegration than that. So, either is the lithotripter not working as it should or is the technique of SWL inferior. It would be desirable to compare the results of stone disintegration following URS with that following carefully conducted SWL, in contrast to what appears to be routinely performed lithotripsy according to standardized protocol. Although it is well recognized that more residuals will be found after SWL than after URS, the question is if the invasive procedure is worth the efforts and also how aggressively minor non-infection stone fragments should be treated. Hans-Göran Tiselius
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