Park J et al, 2012: Shock wave lithotripsy versus ureteroscopy for ureteral calculi: a prospective assessment of patient-reported outcomes
Park J, Shin DW, Chung JH, Lee SW.
Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
Abstract
OBJECTIVE: To compare patient-reported outcomes (PROs) with objective outcomes after shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) for ureteral calculi (UC).
METHODS: We prospectively evaluated 160 consecutive patients who underwent SWL (n = 65) or URS (n = 95) for a single radiopaque UC ranging from 4 to 15 mm. For patients who underwent URS, a 6-Fr double-J stent was routinely placed for 2 weeks after surgery. To examine PRO, we used a self-administered nonvalidated questionnaire evaluating overall satisfaction and PRO in four domains (pain, hematuria, voiding symptom, and time to return to routine activity) and willingness to undergo the treatment procedure again. Propensity-score matching analysis was performed to adjust for potential confounding by discrepancy of pretreatment parameters between groups. Stone-free rates (SFRs) and complications were alsocompared.
RESULTS: SFRs after the first, second, and third sessions of SWL were 61.5, 81.0, and 93.5 %, respectively. SFR after URS was 100 %, which was significantly better than SFRs for third session SWL (p = 0.023). Complications were comparable. By propensity-score matching analysis, overall satisfaction was similar between groups, whereas PRO for voiding symptom and time to return to routine activity were significantly better in the SWL group (all p\0.05). The two groups were not different in willingness to undergo the same procedure again.
CONCLUSIONS: Despite significantly higher SFR after URS for UC, overall patient satisfaction was comparable after SWL and URS, meanwhile PRO of the SWL group was better than URS for voiding symptom and time to return to routine activity. In addition of objective treatment outcomes, PROs should be considered in counseling treatment methods for UC.
World J Urol. 2012 Oct 18. [Epub ahead of print]
PMID: 23076422 [PubMed - as supplied by publisher]
Comments 1
In this retrospective comparison of patients treated with SWL or URS, the important finding was that patients´ satisfaction did not differ between the two groups despite a 100% stone-free rate after one URS procedure compared with only 62% after one SWL session. Moreover, 22 of the patients in the SWL-group were given more than one SWL session. The result of patient satisfaction was the same also when a comparison was carried out between matched patients. The stone-free rate after one SWL session is slightly lower than expected but might be explained by the fact that URS preferably was used for distal ureteral stones (42%) and SWL for proximal stones. Only 12% of distal ureteral stones were treated with SWL. The stone-free rates are comparable with other reports in the literature and it is not obvious to which extent a better outcome of SWL had been possible with another regimen of analgesics and sedatives.
Hans-Göran Tiselius