Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones

Abstract

Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter. Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes. Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients’ demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones. Conclusions: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.

Where Is It Logical to Break-Up A Ureter Stone with Endoscopic Surgery?

“…In a study where they compared fURS with srURS in the treatment of upper ureteral stones, Kartal et al reported that operation times where fURS was performed were significantly longer. 4 Similar findings were also reported by Karadag et al 23 AlthoughÖzkaya et al reported that the use of UAS in patients who underwent fURS shortened the operation time compared to those who did not use UAS, Galal's study comparing fURS with URS showed that operation times where srURS was carried out were significantly shorter. 5,24 In our study, although the average length of operations using srURS were shorter than those using fURS, these differences were not statistically significant.…”

“…Kartal et al reported that they could not find a significant difference in intraoperative complication rates between fURS and srURS in upper ureteral stones. 4 Karadag et al also reported that there was no difference in intraoperative complications. 23 Finally, Galal et al reported no significant difference between both intraoperative and postoperative complications.…”

“…23 Similarly, Kartal et al reported a significant stone-free rate in fURS procedures compared to srURS without antiretropulsion. 4 Galal et al found fURS superior in terms of stone-free rates as a result of their studies comparing rigid URS and fURS, which they performed without using an antiretropulsion device. 5 However, they added the comment that if they had used a Stone Cone ® or N-Trap basket, a higher rate would probably have been achieved using rigid URS.…”

“…Nowadays, if a stone is pushed up, surgeons can stop performing URS and begin using fURS to treat stones in the kidney, allowing surgeries to be completed successfully. 4,5 Different techniques and devices have been used to mitigate the push-up problem. 6,7 However, it is not clear if these methods are truly necessary with today's technology.…”

Effect of Endoscopic Ureteral Stone Treatment on Kidney Function

“…Kartal et al compared treatment options for proximal ureteral stones and reported stone-free rates as 67.2% on the 15th postoperative day and 94.1% on the third postoperative month after semirigid URS. In the same study, stone-free rates for flexible URS were 89.6% and 97%, respectively [13]. Data in the literature demonstrate that urologists can achieve a high success rate for ureteral stones with semirigid URS.…”