Dell'Atti L et al, 2016: Ten-year experience in the management of distal ureteral stones greater than 10 mm in size.
Dell'Atti L, Papa S.
Abstract
AIM: Extracorporeal shock wave lithotripsy (ESWL) and semirigid ureteroscopy lithotripsy (URSL) have become standards of treatment for ureteral calculi. The aim of this retrospective study was to compare ESWL vs. URSL in terms of safety and efficacy for treatment of large distal ureteral stones ≥ 1cm.
PATIENTS AND METHODS: This investigation assessed 637 patients with distal ureteral stones (10 to 15mm in size). 313 in the ESWL group were treated on an outpatient basis using the LithoDiamond machine without anaesthesia. URSL was performed in 324 patients with a 6-8 Fr semirigid ureterorenoscope and YAG laser under spinal anaesthesia. A successful outcome was defined as the patient being stone free 1 month after treatment. For all patients the parameters, including stone-free rate, operation time, complications, were inserted retrospectively in this study after review of medical records and operating room logs.
RESULTS: The stone-free rate after URSL was 77.5% and 45.4% after ESWL treatment (p<0.001). The mean operative time between two groups was 74.7±9.8 for URSL group and 38.3±7.6 for ESWL group. The average number of office visits was 4.2 and 2.6 in patients treated with ESWL and URSL, respectively. Double j stents were inserted in 28.7% of patients. Twenty-one patients needed rehospitalisations for major complications. However, the differences in the overall complication rate were not statistically significant, with a rate of 16.3% for URSL and 14.4% for ESWL (p=0.246).
CONCLUSION: We have shown that URSL has enough safety and efficacy for the treatment of distal ureteral stones ≥ 1cm. URSL is associated with higher stone clearance rate as compared with ESWL.
G Chir. 2016 Jan-Feb;37(1):27-30. FREE ARTICLE
Comments 1
In this retrospective analysis of treatment of ureteral stones (>10 mm) the authors concluded that URS was more successful in terms of stone clearance than SWL.
What kind of stones that the authors really describe is difficult to know? In this regard the report is confusing. Although the title informs the reader that the 10-year experience relates to “distal ureteral stones”, the Methods section gives a definition of the “lower ureter” as the “ureteral segment between the urtereopelvic junction and the upper margin of the sacro-iliac joint”. This is in my mind the proximal ureter and in the same sentence as above the authors mention “ proximal ureteral stones”. So in fact it seems most likely that the authors reported the outcome of proximally located ureteral stones.
It is not clear from the report whether the patients or the urologists did choose the treatment modality. Neither is it mentioned in which position the SWL was carried out. This is of importance provided the stones now were located in the proximal ureter. It had also been of interest to know something about analgesics given during the SWL procedure.