STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Mustafa G. et al., 2024: Comparison of Outcomes of Extracorporeal Shockwave Lithotripsy with Ureteroscopic Lasertripsy for Management of Proximal Ureteral Stones.

Mustafa G, Mahar NA, Qureshi HH, Mustafa M, Fayaz M, Hassan AS.
Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.

Abstract

Objective: To compare the outcomes of extracorporeal shockwave lithotripsy with ureterorenoscopy and lasertripsy for managing upper ureteral stones of size 10mm to 15mm.

Study design: Observational, cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), from December 2020 to December 2021.

Methodology: A total of 168 patients with the diagnosis of proximal ureteric stone of size 1-1.5 cm were enrolled for this study. Patients were divided into two groups by simple random method. Group 1 patients underwent ureteroscopic lithotripsy (URS) and lasertripsy while Group 2 patients were subjected to extracorporeal shockwave lithotripsy (ESWL). Patients' demography, operative time, duration of hospitalisation, complication rate and stone-free rates, were recorded for both groups. Frequency and percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. For comparison of continuous variables, one-way ANOVA was applied, and Chi-square test was applied to compare the categorical variables. The p-value ≤0.05 was taken as significant.

Results: The mean age was of 39.55 ± 14.06 years, with the majority falling within the age group of 26 to 40 years. There were more males (116, 69%) than females (52, 31%). Most of the patients did not have a history of diabetes or hypertension. Sixty-two patients had previous history of stones. The average duration of ureteric stone disease was 3.18 ± 3.14 months. The mean size of the ureteric stone was 10.82 ± 3.19mm. The procedure duration was significantly shorter for URS, as compared to ESWL (33.81 ± 15.42 minutes vs. 45.00 ± 0.00 minutes, p=<0.01. The overall stone clearance rate was significantly higher after URS (83.3%) as compared to ESWL (64.2%, p=0.05).

Conclusion: URS was a superior treatment option as compared to ESWL. However, the selection of the most appropriate procedure should be based on a tailored approach considering the patient's preference and the size of the stones.

J Coll Physicians Surg Pak. 2024 Jan;34(1):101-104. doi: 10.29271/jcpsp.2024.01.101.
PMID: 38185970

0
 

Comments 1

Peter Alken on Tuesday, 25 June 2024 11:00

I completely agree to the conclusion “It is important to consider all relevant parameters before objectively comparing these techniques.”, and I miss those parameters concerning patients’ preferences, quality of life, long term complication rate, costs. Otherwise it is just another comparative report with no new information. The publication market offers a lot of single series on the topic. Whenever meta-analyses and reviews on a topic appear, it is a sign that enough is said and someone felt the need to summarize the experience to get an overview. The manuscript was submitted: December 20, 2022; Revised: July 17, 2023; Accepted: August 31, 2023. So, references beyond Dec.22 may not be considered and included. I nevertheless missed some reviews (1-8).
My opinion towards a comparison of URS vs. ESWL is always influenced by the thought that one major, serious complication in a single patient outweighs all advantages. In the present study the complication rate (Table 1) looks nice at first glance. No details on the 6 Grade III complications in the URS group are given, the one grade “IV complication (urosepsis) was managed by institutional infectious and intensive care protocol.” With a 2-week follow-up the rate of late ureteral strictures is unknown.

https://www.storzmedical.com/images/blog/Mustafa.png

1 Comparison of YAG Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy in Treatment of Ureteral Calculi: A Meta-Analysis. Yang C, Li S, Cui Y. Urol Int. 2017;98(4):373-381. doi: 10.1159/000452610. Epub 2016 Nov 1.PMID: 27798945 Review.
2 Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Aboumarzouk OM, Kata SG, Keeley FX, Nabi G. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006029. doi: 10.1002/14651858.CD006029.pub3. PMID: 22161396 Updated. Review.
3Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Aboumarzouk OM, Kata SG, Keeley FX, McClinton S, Nabi G. Cochrane Database Syst Rev. 2012 May 16;(5):CD006029. doi: 10.1002/14651858.CD006029.pub4. PMID: 22592707 Review.
4 Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Nabi G, Downey P, Keeley F, Watson G, McClinton S. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD006029. doi: 10.1002/14651858.CD006029.pub2. PMID: 17253576 Updated. Review.
5 A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size. Jung HD, Hong Y, Lee JY, Lee SH. Medicina (Kaunas). 2021 Dec 16;57(12):1369. doi: 10.3390/medicina57121369. PMID: 34946314
Free PMC article

6 A meta-analysis of the efficacy of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy on ureteral calculi. Xu Y, Lu Y, Li J, Luo S, Liu Y, Jia Z, Chen P, Guo Y, Zhao Q, Ma X, Jia S. Acta Cir Bras. 2014 May;29(5):346-52. doi: 10.1590/s0102-86502014000500010. PMID: 24863324 Review.
7 Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M.Int J Surg. 2020 Aug;80:205-217. doi: 10.1016/j.ijsu.2020.06.025. Epub 2020 Jul 1. PMID: 32622059
8 Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones

I completely agree to the conclusion “It is important to consider all relevant parameters before objectively comparing these techniques.”, and I miss those parameters concerning patients’ preferences, quality of life, long term complication rate, costs. Otherwise it is just another comparative report with no new information. The publication market offers a lot of single series on the topic. Whenever meta-analyses and reviews on a topic appear, it is a sign that enough is said and someone felt the need to summarize the experience to get an overview. The manuscript was submitted: December 20, 2022; Revised: July 17, 2023; Accepted: August 31, 2023. So, references beyond Dec.22 may not be considered and included. I nevertheless missed some reviews (1-8). My opinion towards a comparison of URS vs. ESWL is always influenced by the thought that one major, serious complication in a single patient outweighs all advantages. In the present study the complication rate (Table 1) looks nice at first glance. No details on the 6 Grade III complications in the URS group are given, the one grade “IV complication (urosepsis) was managed by institutional infectious and intensive care protocol.” With a 2-week follow-up the rate of late ureteral strictures is unknown.  [img]https://www.storzmedical.com/images/blog/Mustafa.png[/img] 1 Comparison of YAG Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy in Treatment of Ureteral Calculi: A Meta-Analysis. Yang C, Li S, Cui Y. Urol Int. 2017;98(4):373-381. doi: 10.1159/000452610. Epub 2016 Nov 1.PMID: 27798945 Review. 2 Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Aboumarzouk OM, Kata SG, Keeley FX, Nabi G. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006029. doi: 10.1002/14651858.CD006029.pub3. PMID: 22161396 Updated. Review. 3Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Aboumarzouk OM, Kata SG, Keeley FX, McClinton S, Nabi G. Cochrane Database Syst Rev. 2012 May 16;(5):CD006029. doi: 10.1002/14651858.CD006029.pub4. PMID: 22592707 Review. 4 Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Nabi G, Downey P, Keeley F, Watson G, McClinton S. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD006029. doi: 10.1002/14651858.CD006029.pub2. PMID: 17253576 Updated. Review. 5 A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size. Jung HD, Hong Y, Lee JY, Lee SH. Medicina (Kaunas). 2021 Dec 16;57(12):1369. doi: 10.3390/medicina57121369. PMID: 34946314 Free PMC article 6 A meta-analysis of the efficacy of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy on ureteral calculi. Xu Y, Lu Y, Li J, Luo S, Liu Y, Jia Z, Chen P, Guo Y, Zhao Q, Ma X, Jia S. Acta Cir Bras. 2014 May;29(5):346-52. doi: 10.1590/s0102-86502014000500010. PMID: 24863324 Review. 7 Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M.Int J Surg. 2020 Aug;80:205-217. doi: 10.1016/j.ijsu.2020.06.025. Epub 2020 Jul 1. PMID: 32622059 8 Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones
Saturday, 13 July 2024