Iqbal N et al, 2018: Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.
Iqbal N, Malik Y, Nadeem U, Khalid M, Pirzada A, Majeed M, Malik HA, Akhter S.
Department of Urology, Shifa International Hospital Islamabad, Islamabad, Pakistan.
Shifa College of Medicine, Islamabad, Pakistan.
OBJECTIVE: To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved.
MATERIAL AND METHODS: We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis.
RESULTS: The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001).
CONCLUSION: The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.
Turk J Urol. 2018 May; 44(3):221-227. doi: 10.5152/tud.2018.41848. Epub 2018 May 1. FREE ARTICLE
This is a retrospective study on two groups of exactly 200 patients each. “As per departmental policy patients were given choice to undergo either URS or SWL after counselling them about the merits and demerits of both types of modalities. This is probably a very good example for a heavily biased report.
“Mean treatment costs for SWL, and URS groups were US $ 320±50, and US $ 1100±150, respectively (p=0.001).” The way costs are calculated is not given.