Irer B. et al., 2019: Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones. Aegean Study Group of the Society of Urological Surgery
Irer B, Sahin MO, Erbatu O, Yildiz A, Ongun S, Cinar O, Cihan A, Sahin M, Sen V, Ucer O, Kizilay F, Bozkurt O.
Departments of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey, Manisa State Hospital, Manisa, Celal Bayar University School of Medicine, Manisa, Dokuz Eylul University School of Medicine, Izmir, Balikesir University School of Medicine, Balıkesir, Bulent Ecevit University School of Medicine, Zonguldak, Nigde Omer Halisdemir University School of Medicine, Nigde,Department of Urology, Ege University School of Medicine, Izmir, Manisa State Hospital, Manisa, Turkey.
PURPOSE: We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. METHODS: The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. RESULTS: Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%, p < 0.001). CONCLUSIONS: The optimal timing; 2-3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.
Aegean Study Group of the Society of Urological Surgery.
World J Urol. 2019 May 16. doi: 10.1007/s00345-019-02809-4. [Epub ahead of print]
The authors quote 4 other studies on the same topic (1-4) of which three simple case–control studies (1,3,4) with similar results are discussed. A matched pair study (2) with URS 14 days after two failed ESWL attempts showed no difference between comparable groups. This study is only referenced but not discussed.
1 Kilinc MF, Doluoglu OG, Karakan T, et al. (2015) Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: is it safe and efficient or dangerous?
Can Urol Assoc J 9:E718 E722
2 Philippou P, Payne D, Davenport K, et al. (2013) Does previous failed ESWL have a negative impact of on the outcome of ureterorenoscopy? A matched pair analysis.
3 Fernandez De la Maza S, Noldus J, Huland H (1999) Ureterorenoscopy (URS) in treatment of ureteral calculi. I. Safety and effectiveness of URS as auxiliary treatment after ESWL. Urologe A 38:128–132
4 Holland R, Margel D, Livne PM, et al. (2006) Retrograde intrarenal surgery as second-line therapy yields a lower success rate. J Endourol 20:556–559