Editorial Comment: Flexible Ureterorenoscopy Versus Shockwave Lithotripsy for Kidney Stones ≤ 2 cm: A Randomized Controlled Trial

Abstract

Bosio et al. conducted a randomized controlled trial to compare the outcomes of flexible ureterorenoscopy (RIRS) versus shockwave lithotripsy (SWL) for kidney stones up to 2 cm. The primary endpoint was stone-free rate (SFR) at 1 month (1). Secondary endpoints were SFR at 6 months and 1 year, complications and secondary treatments. True SFR (zero residual fragments) at 1 month favors RIRS (50.0% vs. 26.5%; p=0.004). In the long run, the authors state that this difference tends to reduce at 6 months 59.4% vs. 40.9%; p=0.032 and no longer be significant at 1 year 55.9% vs. 48.4%; p=0.392 (1). Although it is very difficult to control variables for 1 year, authors suggests that clearance of residual fragments after SWL persists longer than after RIRS. Clearance rate of residual stone fragments ≤ 2 mm after RIRS is about 80% during the first 3 months whereas less than 12% of the residual stone fragments > 2mm (2). Another important point is that patients in the SWL arm were submitted to further treatments during one-year follow-up more than patients in the RIRS arm, including flexible ureterorenoscopy, which could had artificially increased the success of shockwave lithotripsy.This study also compared the outcomes of each treatment from the patient point of view. 87.1% of the patients of the RIRS arm vs. 88.2% of the SWL arm; p=0.845 were satisfied with their own treatment. Despite these good satisfaction rates, there is room for improvement. Patients would not choose the