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Wang P. et al., 2023: Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic

Wang P, Zhan Y, Li J, Liu G, Li Z, Bai S.
Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.

Abstract

Purpose: To compare the effectiveness, safety, and cost between ultrasound-guided shock wave lithotripsy (SWL) with an early second session protocol and ureteroscopy (URS) in patients with proximal ureteral stones using the propensity score matching (PSM) method based on a large prospective study.

Methods: This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or URS) for proximal ureteral stones were enrolled. The stone-free rate (SFR), complications, and cost were recorded. PSM analysis was performed.

Results: A total of 1230 patients were included, of whom 81.1% (998) were treated with SWL and 18.9% (232) were treated with URS. After PSM, the SWL group had an equivalent SFR at one month (88.7 vs. 83.6%, P = 0.114) compared with the URS group. Complications were rare and comparable between the two groups, while the incidence of ureteral injuries was higher in the URS group compared with the SWL group (1.4 vs. 0%, P = 0.011). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001), and the cost was considerably less (2000 vs. 25,053, P < 0.001) in the SWL group compared with the URS group.

Conclusion: This prospective PSM cohort demonstrated that ultrasound-guided SWL with an early second session protocol had equivalent effectiveness but better safety and lower cost compared with URS in the treatment of patients with proximal ureteral stones, whether the stones were radiopaque or radiolucent. These results will facilitate treatment decisions for proximal ureteral stones.
World J Urol. 2023 Feb 2:1-7. doi: 10.1007/s00345-023-04307-0. Online ahead of print. PMID: 36729301. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, 26 May 2023 10:30

This report comprises highly interesting results of US-guided SWL and URS for treatment of proximal ureteral stones. The methods were compared by propensity score matching.

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

This study was carried out during the COVID-19 pandemic whereby it was considered important to avoid aerosol spreading of virus and accordingly to prefer treatment with non-anesthesia requiring procedures. In this perspective it is surprising that patients were allowed to select treatment modality!
SWL was carried out with one primary procedure and one early follow-up session.

The score matching included age, gender, BMI, smoking, comorbidities, and previous stone history. It is of note, however, that SFR almost was the same before score matching.

One highly important message in the article is that the cost of URS was > 12 times higher than the cost of SWL (25 053 ¥ compared with 2 000 ¥).
Nothing is mentioned about any difficulties with US-guided SWL of proximal ureteral stones.

The results are presented in comprehensive Tables, but the result had been much clearer if number of patients, diagnoses etc. in Tables 1 and 2. had been presented without two meaningless decimals!

Hans-Göran Tiselius

This report comprises highly interesting results of US-guided SWL and URS for treatment of proximal ureteral stones. The methods were compared by propensity score matching. [img]https://www.storzmedical.com/images/blog/Wang.png[/img] This study was carried out during the COVID-19 pandemic whereby it was considered important to avoid aerosol spreading of virus and accordingly to prefer treatment with non-anesthesia requiring procedures. In this perspective it is surprising that patients were allowed to select treatment modality! SWL was carried out with one primary procedure and one early follow-up session. The score matching included age, gender, BMI, smoking, comorbidities, and previous stone history. It is of note, however, that SFR almost was the same before score matching. One highly important message in the article is that the cost of URS was > 12 times higher than the cost of SWL (25 053 ¥ compared with 2 000 ¥). Nothing is mentioned about any difficulties with US-guided SWL of proximal ureteral stones. The results are presented in comprehensive Tables, but the result had been much clearer if number of patients, diagnoses etc. in Tables 1 and 2. had been presented without two meaningless decimals! Hans-Göran Tiselius
Saturday, 18 May 2024