Uguz S et al, 2012: Immediate or delayed SWL in ureteric stones: a prospective and randomized study
Uguz S, Senkul T, Soydan H, Ates F, Akyol I, Malkoc E, Baykal KV
Urology Department, GATA Haydarpasa Teaching Hospital, Uskudar, Istanbul, 34668, Turkey
The objective is to compare immediate and delayed SWL as a treatment for ureter stones between 5 and 20 mm. Patients who applied to the emergency department with single, radio opaque ureteric stone of 5-20 mm size were included in the study. Patients were randomized into immediate and delayed SWL groups. SWL were carried out after pain relief in the delayed group. Maximum of three SWL sessions were applied to the patients with stones of 5 mm or bigger in diameter, leaving at least 3 days interval in-between. Stone-free rate after first session was similar in two groups. When CIRF was also considered as success, the success rate of SWL in the immediate SWL group was higher after first session (p = 0.02). Immediate SWL had a greater success rate in upper ureteric stones (p = 0.019). Overall average time required for elimination of stones was shorter in immediate SWL group than delayed SWL group (p = 0.033). The success rate after first SWL session (including CIRF) was 59 % for patients with chronic pain in the delayed group and 100 % for patients with acute pain in the immediate group. According to the hydronephrosis grade, success rates were 71 and 44.4 % for patients with grade 1 or no hydronephrosis in the immediate SWL group, and for patients with grade 2 or larger hydronephrosis in the delayed SWL group, respectively, after first SWL session. Immediate SWL insures stone-free status in a shorter time in cases with renal colicky pain and ureteral stones, particularly upper ureteral stones.
Urol Res. 2012 Dec;40(6):739-44. doi: 10.1007/s00240-012-0490-2. Epub 2012 Jul 5
PMID: 22763796 [PubMed - in process]
In this report patients with 5-20 mm stones in the ureter were subjected to early ( Lithoscope. The results showed that there was a larger fraction of patients with successful disintegration after early than after delayed treatment. After the first treatment session this difference was, however, statistically significant only for proximal ureteral stones. Elimination of stone material was significantly faster in group A than in group B. The bottom-line was that ESWL results in stone-free ureters in a shorter period of time when carried out early. Although this observation is not new the article is a valuable reminder that a better treatment outcome can be expected after early ESWL.