Kartal I. et al., 2020: Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones
Kartal I, Baylan B, Çakıcı MÇ, Sarı S, Selmi V, Ozdemir H, Yalçınkaya F.
Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara.
Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter.
Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes.
Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients' demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones.
Conclusions: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.
Arch Ital Urol Androl. 2020 Apr 6;92(1):39-44. doi: 10.4081/aiua.2020.1.39. PMID: 32255321. FREE ARTICLE
This comparison between flexible URS, semirigid URS and SWL for treatment of 15-20 mm proximal ureteral stones showed, like many other reports: better results with endoscopic than with non-invasive methods. Average results are shown in the table below
The results with SWL are less successful than expected, but the overall outcome pattern is not unlike that in other reports of this kind. It is indeed disappointing that the result of SWL for ureteral stones is not better, because when ureteral stones are disintegrated the fragments will pass!
What I would like to see now is comparative studies in which SWL is at a level like that achieved with endoscopic methods. Such a development might need improved treatment technology, improved treatment technique, adequate pain treatment and use of different tricks to optimize stone disintegration. Is SWL carried out in too standard ways with insufficient attention to the details of the procedure and with insufficient enthusiasm?