Comparison of Shock Wave Lithotripsy and Flexible Ureterorenoscopy in the Treatment of 10–20 mm Lower Pole Stone: Prospective Non-randomized Study

Abstract

Introduction:The objective of the study is to clarify the efficiency, safety, and limitations of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) in the management of lower pole stones (LPS).Methods: The present study was planned prospectively in a non-randomized manner. Patients who had LPS between 10 and 20 cm in size were enrolled in the study. Patient demographic characteristics, stone-related parameters, complications, and success were noted. Patients who underwent SWL and patients who underwent f-URS were compared according to demographic characteristics, procedure-related parameters, complications, and success rate.Results: A total of 82 patients matched the study inclusion criteria, with 44 patients treated with SWL and 38 patients treated with f-URS. The time between diagnosis and the end of the treatment was 29.2 days in the SWL group and 15.2 days in the f-URS group (p = 0.001). The success rate was 89.5% with f-URS and 72.7% with SWL (p = 0.036). Receiver operating curve analysis revealed that a stone size larger than 14 mm in the lower pole was significantly associated with SWL failure (area under the curve [AUC]: 0.711, p = 0.033), and a stone size larger than 16 mm was a predictive factor for f-URS failure. Conclusion:The present study found that f-URS had a significantly higher stone-free rate in the management of 10-20 mm LPS compared to SWL. For the first time, this study showed that the time between diagnosis and the end of treatment was significantly shorter with f-URS. Moreover, LPS larger than 14 mm and 16 mm were predictive factors for SWL and f-URS failure, respectively.

Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

“…However, the SFR of ESWL is affected by many factors, such as the patient’s BMI and stone density. The reported success rate of ESWL for 10–20 mm LPS is 23% to 85% [ 6 , 11 , 14 ]. Recent data have proved that FURS could be an optimal approach for LPS [ 1 , 8 – 11 ].…”

“…The European Association of Urology (EAU) guidelines recommend Extracorporeal Shock Wave Lithotripsy (ESWL) as the first-line treatment for LPS < 10 mm, while Percutaneous Nephrolithotripsy (PCNL) is preferred for LPS > 20 mm [ 5 ]. For LPS of 10–20 mm, ESWL is also recommended, but the reported stone-free rate (SFR) is poor [ 6 , 7 ]. PCNL could achieve excellent SFR but is limited by a greater risk of hemorrhage.…”

Der 1 cm UKG-Stein: ESWL, URS oder Mini-PCNL? Leitlinien versus Realität

“…Berichtet wird über 161 Patienten (93 ESWL, 68 RIRS), und die Ergebnisse sind hier eindeutig: obwohl die Steinlast größer war, erzielte die endoskopische Intervention signifikant häufiger Steinfreiheit und geringere Re-Interventionsraten bei vergleichbaren Komplikationszahlen [11]. Dieses Bild bestätigt die aktuelle, prospektiv nicht randomisierte Studie von Kezer [12], die darüber hinaus darlegt, dass die Gesamtbehandlungsdauer bei RIRS kürzer ist, was der Tatsache Rechnung trägt, dass bei der ESWL im Regelfall mehrere Sitzungen notwendig sind. Zunehmende Steingröße war in dieser Arbeit für beide Modalitäten ein negativer Prädiktor für die Steinfreiheit.…”