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Yürük E et al, 2015: Previous shock-wave lithotripsy treatment does not impact the outcomes of flexible ureterorenoscopy.

Yürük E, Binbay M, Akman T, Özgör F, Berberoğlu Y, Müslümanoğlu AY.
Department of Urology, Haseki Training and Research Hospital, İstanbul, Turkey.

Abstract

OBJECTIVE: Shock-wave lithotripsy (SWL) is the first-line treatment for the active removal of small and medium-sized kidney stones. Flexible ureterorenoscopy (fURS) is recommended after failed SWL treatment. The aim of this retrospective analysis is to evaluate whether prior unsuccessful SWL treatments affect the outcomes of fURS.
MATERIAL AND METHODS: Data from 206 patients who underwent fURS for the treatment of renal stones between September 2009 and January 2011 were collected, and the patients were divided into two groups according to their previous SWL treatment. The patient demographics, stone characteristics, operation and fluoroscopy times, stone-free rates and complications were compared.
RESULTS: Of the patients, 114 (55.3%) did not undergo SWL prior to fURS (Group 1), whereas 92 (44.6%) completed a minimum of 3 sessions of SWL and waited at least 2 weeks before the fURS operation (Group 2). Although the mean stone number was higher in Group 2, this difference was not significant (p=0.06). The mean operation (p=0.12) and fluoroscopy times (p=0.69) were similar between the groups. The mean operation time per mm(2) stone and fluoroscopy time per mm(2) stone were not significantly different (p=0.64 and p=0.76, respectively). The length of the hospitalization and the overall complication rates were similar. After the third postoperative month, the stone-free rates were not different between the groups (82.5% and 86.9%, respectively, p=0.38).
CONCLUSION: The stone-free and complication rates of fURS were not affected by previous SWL therapy.

Turk J Urol. 2014 Dec;40(4):211-5. doi: 10.5152/tud.2014.83446 

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Comments 1

Hans-Göran Tiselius on Wednesday, 23 December 2015 11:01

The demonstration that an intial SWL does not negatively influence the outome of a subsequent fURS procedure is valauble information. Accordingly a combined approach with both treatment modalities might thus occasionally be an attrative alternative.

There is unfortunately no information on stone composition or how unsuccessful the preceeding SWL of stones in Group 2 was. Obviously stone disintegration occurred to some extent because it is described that fragments were encountered in all parts of the kidney.

It should be noted that also with fURS residual fragments were reported in 18 and 13% of the patients in Groups 1and 2, respectively.

The authors should be complemened for reporting operating and fluoroscopy time in relation to the stone surface area (mm2).

By using average estimates for missing variables I calculated the stone treatment index (STI) for the two groups, only taking into account the URS procedure. STI was 4.04 for patients in group 1 and 3.40 for patients in Group 2.

The demonstration that an intial SWL does not negatively influence the outome of a subsequent fURS procedure is valauble information. Accordingly a combined approach with both treatment modalities might thus occasionally be an attrative alternative. There is unfortunately no information on stone composition or how unsuccessful the preceeding SWL of stones in Group 2 was. Obviously stone disintegration occurred to some extent because it is described that fragments were encountered in all parts of the kidney. It should be noted that also with fURS residual fragments were reported in 18 and 13% of the patients in Groups 1and 2, respectively. The authors should be complemened for reporting operating and fluoroscopy time in relation to the stone surface area (mm2). By using average estimates for missing variables I calculated the stone treatment index (STI) for the two groups, only taking into account the URS procedure. STI was 4.04 for patients in group 1 and 3.40 for patients in Group 2.
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