Cui X et al, 2015: Comparison Between Extracorporeal Shock Wave Lithotripsy and Ureteroscopic Lithotripsy for Treating Large Proximal Ureteral Stones: A Meta-analysis.
Cui X, Ji F, Yan H, Ou TW, Jia CS, He XZ, Gao W, Wang Q, Cui B, Wu JT.
Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
OBJECTIVE: To compare extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) in terms of efficacy, complications, and overall efficiency in the management of proximal ureteral calculi. ESWL and URSL are the 2 most common modalities for treating ureteral stones. Previous studies and meta-analyses suggest that for stones <10 mm, ESWL is safer and of comparable efficacy compared with URSL. However, the choice between one modality over the other for the treatment of stones >10 mm is not as clear.
METHODS: The literature was reviewed in the databases, and resulting reports were screened for relevance. This process yielded 10 articles, which were analyzed in terms of the initial stone-free rate (primary outcome measure) compared between the 2 treatment modalities. Pretreatment rate, operation time, auxiliary procedure rate, and complication rate constituted secondary measures in the analysis.
RESULTS: A statistically higher initial stone-free rate was demonstrated for URSL compared with ESWL (odds ratio [OR] = 0.349; 95% confidence interval [CI] = 0.183-0.666; P = .001). ESWL showed a statistically higher retreatment rate compared with URSL (OR = 7.192; 95% CI = 4.934-10.482; P <.001). The 2 treatment modalities did not show statistically significant differences in mean operating time (OR = 10.35; 95% CI = -0.29 to 20.99; P = .056), auxiliary procedure rate (OR = 1.043; 95% CI = 0.415-2.616; P = .929), or in the complication rate (OR = 0.78; 95% CI = 0.304-1.984; P = .598).
CONCLUSION: For treating large (>10 mm) proximate ureteral stones, URSL tends to be more effective than ESWL, yet without adding significant risk.
Urology. 2015 Apr;85(4):748-56. doi: 10.1016/j.urology.2014.11.041. Epub 2015 Feb 10.
In this meta-analysis the authors conclude that URS should be the preferred treatment for >10 mm large proximal ureteral stones. The basis for this conclusion was that the initial stone-free rate was higher with URS than with ESWL. That is a finding well-known from numerous studies and clinical observations. On the other hand SWL can be carried out without general or regional anaesthesia in the out-patient department and thus without the need of an operating theatre, but NOT, as stated by the authors, without operating skill. The latter aspect is perhaps the most common misconception for ESWL because without extensive experience and training treatment results with ESWL will remain inferior.
That SWL for stones in the kidney is associated with lower stone clearance than that seen after PNL is different from the results with ureteral stones. Most patients with ureteral stones can be rendered stone-free with the non-invasive approach.