Erdogan E. et al., 2025: Outcomes of 10-20 mm Renal Stones: Shock Wave Lithotripsy versus Flexible Ureteroscopy.

Erdogan E, Erdoğan E, Kanberoğlu AF, Aşık A, Sarıca G, Sarıca K.
Urol Int. 2025;109(6):553-559. doi: 10.1159/000545108

Abstract

Introduction: The aim of this study was to compare the efficacy and safety of shock wave lithotripsy (SWL) and flexible ureteroscopy (fURS) in treating unilateral moderate-sized (10-20 mm) kidney stones, with a focus on changes in quality of life (QoL).

Methods: This study included 112 patients with unilateral radiopaque kidney stones. Patients were divided into two groups: SWL (n = 64) and fURS (n = 48). Treatment outcomes, including QoL changes, were evaluated comparatively between the groups.

Results: Both groups were similar in terms of age, gender, stone size, and density. Short-term (4-week) stone-free rates (SFRs) were higher in the fURS group (79.17% vs. 51.56%, p = 0.003). However, at 3 months, there was no significant difference in SFRs (89.8% vs. 85.2%, p = 0.098). Pain levels, assessed using the Visual Analog Scale, showed no difference 1-h post-procedure (p = 0.338), but SWL had lower pain scores at 4 h (p = 0.002). QoL, assessed with the SF-36 questionnaire, indicated an advantage for SWL in energy/fatigue parameters (p = 0.017), with no significant differences in other domains. SWL was particularly beneficial for energy levels and emotional well-being.

Conclusions: SWL's noninvasive nature, reduced pain levels, and advantages in specific QoL parameters make it an effective treatment option for medium-sized kidney stones. While fURS offers better short-term stone clearance, SWL demonstrates comparable long-term efficacy with added QoL benefits.

Comment Hans-Göran Tiselius

Many studies have been published in which fURS and SWL have been compared. This article is another one, mentioned to have its main focus on QoL issues.
There were 112 patients with 10-20 mm stones in the kidney randomized to the two groups. There were 64 patients treated with fURS and 48 with SWL. The different number of patients in the two groups is not clearly explained.
The stone-free rates after 1 month were 79% for URS and 52% for SWL. The 3-month results were 90 and 85%, respectively. Which is similar to data reported in two other recent articles referred to [1,2]. It is the long-term follow-up that is of greatest interest
Although commonly used, I have some doubts if NSAID is optimal pain treatment in SWL but this was obviously the routine that was applied.
The QoL analysis was in favor of SWL for most variables, particularly for pain experience.
References
1.    Cecen K, Karadag MA, Demir A, BagciogluM, Kocaaslan R, Sofikerim M. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for the treatment of upper/middle calyx kidney stones of 10–20 mm: a retrospective analysis of 174 patients.SpringerPlus. 2014;3(1):557. https://doi.org/10.1186/2193-1801-3-557
2.    Fankhauser CD,Weber D,MüntenerM, PoyetC, Sulser T, Hermanns T. Effectiveness   of flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for renal calculi of5–15 mm: results of a randomized controlled trial. Eur Urol Open Sci. 2021;25:5–10. https://doi.org/10.1016/j.euros.2021.01.001

Hans-Göran Tiselius