Yazici CM. et al., 2021: Does extracorporeal shock wave lithotripsy before retrograde intrarenal surgery complicates the surgery for upper ureter stone? The results of the RIRSearch group
Yazici CM, Siddikoglu D, Cinar O, Ozman O, Basatac C, Akgul M, Sancak EB, Onal B, Akpinar H.
Department of Urology, School of Medicine, Namık Kemal University, Tekirdag, Turkey.
Department of Statistics, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Clinic of Urology, Gaziosmanpasa Training Hospital, Istanbul, Turkey.
Department of Urology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey.
Department of Urology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
Department of Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
Aims: To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones.
Methods: The patients in the study population were divided into two groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalisation time and stone-free rates were compared between the groups.
Results: There were 56 patients in Group 1 and 95 patients in Group 2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group 1 (P = .043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status.
Conclusion: Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient's last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications.
Int J Clin Pract. 2021 Feb 26:e14115. doi: 10.1111/ijcp.14115. Online ahead of print. PMID: 33636023
This is a retrospective analysis of patients treated in four different hospitals in a 7 years period. There are no details about the ESWL treatment except the number of ESWL sessions and the time between the last ESWL session and the RIRS.
The authors do not address the probably very strong bias of patient and procedure selection in the two groups, which limits the significance of the conclusions.