Erdoğan E. et al., 2025: What is the preferred management of lower ureteral stones? SWL or URS - a critical evaluation with an emphasis on the changes in patient's quality of life.

Erhan Erdoğan, Alper Aşık, Hikmet Yaşar, Göksu Sarıca, Kemal Sarıca 
Urolithiasis. 2025 Feb 13;53(1):29. doi: 10.1007/s00240-025-01693-5

Abstract

To compare the efficacy and safety of two treatment methods for lower ureteral stones: shock wave lithotripsy (SWL) and ureteroscopic treatment (URS), with a focus on the impact on patients' Quality of Life (QoL). A total of 174 patients with solitary radiopaque lower ureteral stones (5-10 mm) between July 2023 and October 2024 were treated with SWL (78 patients) or URS (96 patients). Stone-free (SF) status was evaluated at 3 months using Non-Contrast Computed Tomography (NCCT). Data included age, gender, body mass index (BMI), stone size, and post-procedural analgesic requirement. QoL was measured using the Short Form-36 (SF-36) index. Although SF rates were significantly higher in the URS group (96.9% vs. 84.6%, p = 0.009), comparable SF rates for stones < 10 mm and symptom-free status during long-term follow-up suggest that SWL remains a valuable alternative. Additionally, 96.2% of patients expressed willingness to choose SWL again, highlighting patient satisfaction. SWL produced similar results to URS in physical functioning and general health, but URS showed better outcomes in pain and emotional well-being, possibly due to residual stone fragments. SWL offers advantages such as shorter recovery times, reduced need for pain medication, and no requirement for general anesthesia, making it a preferred option for patients seeking non-invasive treatment. Both methods showed similar outcomes in QoL, particularly in physical functioning and general health, demonstrating that SWL is an effective non-invasive treatment for lower ureteric stones.

Comment Hans-Göran Tiselius

Despite the technical development of endoscopic instruments, selection of method for removal of ureteral stones remains a matter of concern. This problem also is relflected in the observations of increased URS and decreased SWL.
The authors of this report aimed to study the effects and patients’ experience of the two methods for treatment of distal ureteral stones. There were 78 patients treated with SWL and 96 patients treated with URS. I cannot see, however, how patients were selected and referred to each one of the two methods. Analysis of success, complications and QoL provided the basis for conclusions.
The success rates were 85% and 97% for SWL and URS, respectively. It is surprising, however, that the SWL success rate after one session only was 47%, a level definitely lower than expected. It is of note, that despite differences in stone-free rates, 92% of the SWL patients would choose the same method in case of repeated treatment. The corresponding percentage for URS was 83.3%
The non-invasiveness of SWL without need of general or regional anesthesia speak in favour of SWL despite need of retreatment in up to 84.6% .

Hans-Göran Tiselius