Farag M. et al., 2022: Which has more complications?-Shockwave lithotripsy versus endoscopic treatment of renal calculi with 1-year follow-up in an Australian population.
Farag M, Jack GS, Papa N, Wong LM, Bolton DM, Lenaghan D.
Department of Urology Austin Health, University of Melbourne Heidelberg VIC Australia.
Department of Surgery St Vincent's Hospital Melbourne Fitzroy Australia.
Abstract
Introduction and objectives: Renal calculi are a common medical problem with incidence rates calculated to be approximately 6%-9% in men & 3%-4% in women worldwide. Incidence appears to be increasing. This study compares emergency presentations and unplanned readmissions between extracorporeal shock wave lithotripsy (SWL) and pyeloscopic stone treatment in the population of Victoria, Australia after 1-year follow-up.
Methods: This is a population study comparing all patients with renal calculi electively treated with SWL to those initially treated with flexible ureteroscopy (URS) in Victoria, Australia. We used data linkage across the state of Victoria to follow patients treated with either modality in a 12 months period (with no urological surgery in the prior 12 months). Each patient's emergency presentations and subsequent re-admissions were followed up for 1 year after their index treatment to assess for stone complications. We assessed for selection bias between the two patient groups by comparing age, gender, insurance status, geographical location, and comorbidity scores.
Results: We report stone-related complications for 739 flexible URS and 1317 SWL procedures undertaken across public and private hospitals in Victoria over 12 months. Unplanned emergency presentations within 60-days of surgery were (22/739) 2.98% for flexible URS patients and (83/1317) 6.30% for SWL patients (P = .001); however, at 12 months, this became 16.23% (120/739) for flexible URS patients and 12.83% (169/1317) for SWL patients (P = .034). Flexible URS patients were more likely than SWL patients to be admitted with 71.76% of flexible URS versus 53.97% of SWL patients requiring an admission at any given emergency presentation (P ≤ .001) within 12 months. On multivariate analysis, both flexible URS ([OR] 1.67, CI 1.23-2.26, P = .001) and being a public patient ([OR] 3.06, CI 2.24-4.18, P < .001) significantly increased the likelihood that patients required an unplanned re-admission within 12 months.
Conclusions: There is work needed to reduce emergency presentations and unplanned re-admissions after both SWL and flexible URS. At 12-months follow-up, unplanned emergency visits and re-admission rates were significantly more after flexible URS. Symptoms at emergency presentation indicate that better education regarding stent management is needed, especially in the public health care system.
BJUI Compass. 2021 Jul 1;2(4):275-280. doi: 10.1002/bco2.71. eCollection 2021 Jul. PMID: 35475295. FREE ARTICLE
Comments 1
In view of the possible choice of method for removal of stones roach (URS) is associated with more complications than SWL? This was the question asked in this retrospective study of 739 patients treated with URS and 1317 treated with SWL for stones in the kidney. The recorded outcomes were unplanned emergency presentations and re-admissions.
The most important findings are shown in this table.
There is no information on what kind of problems that brought the patients back to the emergency unit, neither is there any information on which kind of post-procedure treatment that was given. Diclofenac? Alpha receptor antagonists? Stone sizes for the two groups are not shown.
One point that is emphasized by the authors is that re-admission was increased by 40% in public health care system. Moreover, it was 3.06 more likely that these patients were re-admitted during the 12 months period. That finding might be specific for the region in which the study was carried out?
It is difficult to draw definite conclusions from this report because of insufficient supply of details, but it is obvious that for fURS there is greater risk of unplanned emergency visits up to 12 months.
Hans-Göran Tiselius