Mancuso M. et al., 2022: Characterizing patients with multiple same-sided ureteric stones.
Mancuso M, Lavoie C, Assmus M, De S.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Division of Urology, University of Alberta, Edmonton, AB, Canada.
School of Medicine, Indiana University, Indianapolis, IN, USA.
Division of Urology, University of Alberta, Edmonton, AB, Canada.
Abstract
Purpose: Patients presenting with multiple same-sided ureteric stones (MSSUS) are a unique population with nuanced prognostic and treatment considerations, which have yet to be characterized in the literature. Therefore, our purpose was to examine outcomes of patients with MSSUS vs those with single ureteric stones (SUS).
Methods: A retrospective review of prospectively collected patients included adults (> 18yo) with [Formula: see text] 2 ipsilateral ureteral stones without prior treatment for their current stone burden. A historical comparison group was used as a control population. Univariate logistic regression analyses and descriptive statistics were performed with SPSS® 20.0 (p < 0.05).
Results: Seventy-nine MSSUS patients were compared to 101 SUS patients. MSSUS patients had 2.21 [Formula: see text] 0.66 ureteric stones and had significantly smaller lead stones (MSSUS 6.4 mm vs SUS 7.2 mm, p = 0.03). MSSUS patients were more likely to have had prior stones (66 vs 42%) and 5.9 times more likely to have had prior stone procedures. Conservative management was successful in 30% MSSUS vs 19% SUS (p = 0.073), and there were no differences in resolution time (p = 0.44). For patients proceeding to intervention, (MSSUS n = 52, SUS n = 78), ureteroscopy was performed on 58% MSSUS vs 51% SUS patients (p = 0.302), and shockwave lithotripsy in 10% MSSUS vs 26% SUS (p = 0.01). MSSUS were more likely to spontaneously pass a stone prior to planned intervention (OR = 41.1; 95% CI = 12.0-140.7; p = 0.0001).
Conclusion: MSSUS patients are more likely recurrent stone formers with extensive stone histories and current stone burdens. Conservative management appears as successful between groups, with no difference in resolution time. When employed, ureteroscopy outcomes do not different between cohorts.
World J Urol. 2022 May 27. doi: 10.1007/s00345-022-04035-x. Online ahead of print. PMID: 35622115
Comments 1
The purpose of this report was to compare patients with multiple (2.2±0.7) stones (MSSUS) and those with one (1±0) ureteral stone (SUS) on the same side.
The results in this report are partly obscured by the discrepancy between data in the text and data in the tables. One example is that in the Results section 10% of patients in the MSSUS were treated with SWL, while the corresponding number in Table 4 is 14%. That as many as 62% of the treatments failed is surprising.
The arguments for the low application of SWL are vague and it seems as SWL was carried out at a low level of ambition.
It is the reviewer’s opinion that SWL had been an excellent first line treatment of stones both in MSSUS and SUS patients.
The comparison between the two groups is hampered by differences in stone locations and lack of stone analysis in the SUS-group
Hans-Göran Tiselius