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Ceylan Y et al, 2017: The effect of SWL and URS on health-related quality of life in proximal ureteral stones.

Ceylan Y, Ucer O, Bozkurt O, Gunlusoy B, Mertoglu O, Zumrutbas AE, Yildiz G, Irer B, Muezzinoglu T, Demir O.
Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey.
Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
Department of Urology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training, Research Hospital, İzmir, Turkey.
Department of Urology, Esrefpaşa Hospital, Izmir, Turkey.

Abstract

OBJECTIVES: We aimed to compare the effect of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URS) on health-related quality of life (HRQoL) for the treatment of proximal ureteral stones. MATERIAL AND METHODS: Between April 2014 and July 2015, patients with proximal ureteral stones who were successfully treated with URS or SWL in seven different centers were included. Patients were divided into two groups according to stone size: stones ≤10 mm and >10 mm. HRQoL subscales which were evaluated by the Medical Outcome Study Short-Form 36-item survey (SF-36) Turkish version were compared for URS and SWL in these two groups one month after the performed procedure.
RESULTS: A total of 273 patients were included in the study. While 116 (52.5%) patients were treated with ureteroscopic lithotripsy, SWL was used for 105 (47.5%) patients. Fifty-two patients were excluded from the study. In proximal ureteral stones ≤10 mm, there were no statistically significant differences for any of the eight subscales of the SF-36 questionnaire. Regarding stones >10 mm, it was found that the three subscales of the SF-36 questionnaire - role limitations because of physical health problems (RP), bodily pain (BP), and general health perception (GH) - were significantly lower in the SWL group compared with the URS group.
CONCLUSIONS: Patients with proximal ureteral stones >10 mm who were treated with URS generally may have a more favorable HRQoL than those treated with SWL in short-term follow-up.

Minim Invasive Ther Allied Technol. 2017 Jul 12:1-5. doi: 10.1080/13645706.2017.1350719. [Epub ahead of print]

 

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Commentaires 1

Hans-Göran Tiselius le vendredi 26 janvier 2018 09:14

The authors analysed short-term HRQoL-scores in patients treated with URS or SWL for proximal ureteral stones. The conclusion was that patients with stones >10 mm and treated with URS had significantly better QoL-score than those treated with SWL.
There are, however, some problems with this comparison and it is for instance not mentioned to which extent repeated SWL-sessions influenced the score. It is of note that the mean number of SWL sessions was 2.87, a relatively high and unexpected re-treatment rate. Is it possible that the need of repeated treatments was a consequence of suboptimal pain-relief during SWL?
It is stated that only patients who were treated successfully were included in the comparison, but there were obviously some patients who had residual fragments (≤ 4 mm) in the ureter. Successful treatment of ureteral stones in the reviewer’s opinion means a completely stone-free ureter. But it is not mentioned in the article to which extent the two groups differed in this regard. It had also been much easier to appraise the differences in HRQoL if the treatment results had been described in more detail.

The authors analysed short-term HRQoL-scores in patients treated with URS or SWL for proximal ureteral stones. The conclusion was that patients with stones >10 mm and treated with URS had significantly better QoL-score than those treated with SWL. There are, however, some problems with this comparison and it is for instance not mentioned to which extent repeated SWL-sessions influenced the score. It is of note that the mean number of SWL sessions was 2.87, a relatively high and unexpected re-treatment rate. Is it possible that the need of repeated treatments was a consequence of suboptimal pain-relief during SWL? It is stated that only patients who were treated successfully were included in the comparison, but there were obviously some patients who had residual fragments (≤ 4 mm) in the ureter. Successful treatment of ureteral stones in the reviewer’s opinion means a completely stone-free ureter. But it is not mentioned in the article to which extent the two groups differed in this regard. It had also been much easier to appraise the differences in HRQoL if the treatment results had been described in more detail.
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