Erdoğan E. et al., 2025: Outcomes of 10-20 mm Renal Stones: SWL vs. Flexible Ureteroscopy.

Erhan Erdoğan 1, Ahmet Fatih Kanberoğlu 1, Alper Aşık 1, Göksu Sarıca 2, Kemal Sarıca 1 3
1Department of Urology, Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey.
2Biruni University Medical School, Istanbul, Turkey.
3Department of Urology, Biruni University Medical School, Istanbul, Turkey.

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.

Urol Int. 2025 Mar 7:1-14. doi: 10.1159/000545108. Online ahead of print. PMID: 40058343