Chen H. et al., 2019: No Wound for Stones iew of Comparative Studies

Tuesday, 01 October 2019

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Chen H, Chen G, Pan Y, Zhu Y, Xiong C, Chen H, Yang Z.
Department of Urology, The First Affiliated Hospital of Chongqing Medical, Chongqing, China.

Abstract

INTRODUCTION: No wound to the patients is the pursuit of surgeons. Extracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS) are minimally invasive modalities for treating horseshoe kidney (HSK) stone <2 cm. We aimed to review the outcomes and complications of comparing SWL and URS in HSK stone. METHODS: The literature was reviewed in the Embase, PubMed, and Cochrane Library up to March 1, 2018. Only 4 articles were available for analysis. Inclusion criteria were all English language articles reporting on the comparison between SWL and URS. RESULTS: URS tends to be performed in a relatively heavier stone burden. The higher initial stone-free rate and success rate were demonstrated for URS than for SWL (p < 0.00001, p = 0.02, respectively). The less retreatment rate was found in URS than SWL (p = 0.04). There was no difference in minor complications in the 2 groups (p = 0.57). Renal colic episodes were more likely to be observed in the SWL group (p = 0.02). There were no major complications found in the review. CONCLUSION: For a stone <2 cm in HSK, both SWL and URS are safe treatment modalities. URS alone is a more feasible and sufficient option for stone in HSK <2 cm than SWL with possibilities of a second session.

Urol Int. 2019 May 16:1-7. doi: 10.1159/000500328. [Epub ahead of print] Review.

Comments 1

Hans-Göran Tiselius on Tuesday, 01 October 2019 11:18

Stone removal from horseshoe kidneys is a well recognized clinical problem. With non-/low-invasive treatment in mind the authors carried out a retrospective literature comparison between SWL and URS.

For successful SWL there are two problems. Firstly it is necessary to place the patient in a position that avoids interference between the shockwave path and the skeleton; in most cases the spine. Secondly it is necessary to have a lithotripter with sufficient penetration depth if shockwaves are delivered from the back (or occasionally also transabdominally). If these factors can be dealt with appropriately, elimination of fragments often is counteracted by the complex outflow anatomy in horseshoe kidneys.

One of the problems with the statistical analysis reported in this article is that a selection of patients had been carried out when the treatment method was decided.[Another and more curious and confusing feature is that the authors have used different author names for the references in Table 1 (family name) and in Figures 2-6 (first name)].

It is evident that selection of the most appropriate patient is fundamental for the success of SWL, and that RIRS in several cases is the superior method.

As in most reports today the authors conclude in the final part of the article that further randomized studies are necessary. Although such a step is essential in many clinical and medical issues, in my mind this is not the case for treatment of stones in horseshoe kidneys. The fundamental question that needs an answer is if the outflow anatomy will allow passage of fragments or not. If this question cannot be given a reasonably positive answer an attempt with SWL as a first step might be worthwhile. Otherwise it seems wise to choose an alternative method; RIRS or PCNL.

Stone removal from horseshoe kidneys is a well recognized clinical problem. With non-/low-invasive treatment in mind the authors carried out a retrospective literature comparison between SWL and URS.

For successful SWL there are two problems. Firstly it is necessary to place the patient in a position that avoids interference between the shockwave path and the skeleton; in most cases the spine. Secondly it is necessary to have a lithotripter with sufficient penetration depth if shockwaves are delivered from the back (or occasionally also transabdominally). If these factors can be dealt with appropriately, elimination of fragments often is counteracted by the complex outflow anatomy in horseshoe kidneys.

One of the problems with the statistical analysis reported in this article is that a selection of patients had been carried out when the treatment method was decided.[Another and more curious and confusing feature is that the authors have used different author names for the references in Table 1 (family name) and in Figures 2-6 (first name)].

It is evident that selection of the most appropriate patient is fundamental for the success of SWL, and that RIRS in several cases is the superior method.

As in most reports today the authors conclude in the final part of the article that further randomized studies are necessary. Although such a step is essential in many clinical and medical issues, in my mind this is not the case for treatment of stones in horseshoe kidneys. The fundamental question that needs an answer is if the outflow anatomy will allow passage of fragments or not. If this question cannot be given a reasonably positive answer an attempt with SWL as a first step might be worthwhile. Otherwise it seems wise to choose an alternative method; RIRS or PCNL.

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