El-Nahas AR et al, 2012: Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ
Urology Department, Urology and Nephrology Center, Mansoura University Urology Department, Fayoum University, Egypt
What's known on the subject? and What does the study add? Shock wave lithotripsy and flexible ureterorenoscopy are acceptable treatment options for lower pole stones smaller than 10 mm, while percutaneous nephrolithotomy is the favoured treatment for stones larger than 20 mm. For treatment of lower pole stones of 10-20 mm, flexible ureterorenoscopy has a significantly higher stone-free rate and lower retreatment rate than shock wave lithotripsy.
OBJECTIVE: To compare the outcomes of flexible ureterorenoscopy (F-URS) and extracorporeal shock wave lithotripsy (ESWL) for treatment of lower pole stones of 10-20 mm.
PATIENTS AND METHODS: The database of patients with a single lower pole stone of 10-20 mm was examined to obtain two matched groups who were treated with F-URS or ESWL. Matching criteria were stone length, side and patient gender. • Stone-free rates were evaluated 3 months after the last treatment session by non-contrast computed tomography. Both groups were compared for retreatment rate, complications and stone-free rate.
RESULTS: The matched groups included 37 patients who underwent F-URS and 62 patients who underwent ESWL. Retreatment rate was significantly higher for ESWL (60% vs 8%, P < 0.001). Complications were more after F-URS (13.5% vs 4.8%), but the difference was not significant (P= 0.146). All complications were grade II or IIIa on modified Clavien classification. The stone-free rate was significantly better after F-URS (86.5% vs 67.7%, P= 0.038). One failure of F-URS (2.7%) and five failures (8%) of ESWL were treated with percutaneous nephrolithotomy. Significant residual fragments in three patients (8%) after F-URS were treated with ESWL, while significant residual fragments after ESWL in five patients (8%) were treated with F-URS. Residual fragments (CONCLUSIONS:
For treatment of lower pole stones of 10-20 mm, F-URS provided significantly higher stone-free rate and lower retreatment rate compared with ESWL. The incidence of complications after F-URS was not significantly more than after ESWL.
© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL
BJU Int. 2012 Sep;110(6):898-902. doi: 10.1111/j.1464-410X.2012.10961.x. Epub 2012 Feb 28
PMID: 22372915 [PubMed - indexed for MEDLINE]. FREE ARTICLE
This paper on the treatment of lower pole stones is heavily biased: 708 patients were treated with ESWL and 47with flexible URS in. Data from 37 URS patients and 62 ESWL patients were used for a matched group analysis. All ureteroscopies were performed by a single surgeon. I wonder what the outcome would have been if a devoted physician would have done the 62 cases of EWSL.