Khalil M, 2013: Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy
Department of Surgery, Division of Urology, Mubarak Al-Kabir Hospital, Ministry of Health, Hawally, Kuwait
OBJECTIVE: PROSPECTIVE EVALUATION OF THE EFFICACY AND SAFETY OF THE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (SWL) AND URETEROSCOPY WITH HOLMIUM: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter.
PATIENTS AND METHODS: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study.
Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed.
RESULTS: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively).
CONCLUSION: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.
Urol Ann. 2013 Apr;5(2):88-92. doi: 10.4103/0974-7796.110004
PMID:23798864 [PubMed] PMCID:PMC3685752. FREE ARTICLE
What happened in this series when SWL or URS failed or required additional interventions?
There is significant difference in the retreatment rate but probably not in the secondary intervention rate of the two procedures.
All URS were done under general anesthesia. It is not stated how many patients had a ureteral stent that was left in place for 4-6 weeks, caused inconvenience and had to be removed by cystoscopy. With a not significant different residual stone rate at 3 months of 19,8% URS and 21,6% for SWL the question remains which is really the less invasive procedure.