Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi

Abstract

The goal of this study was to compare the effectiveness and complications of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (SWL) in the management of patients with proximal ureteral stones. Methods In this trial, 150 patients presenting with proximal ureteral stones at the Department of Urology of Nishter Hospital Multan from November 2018 to November 2019 were allocated 1:1 to undergo URS or SWL. The presence of stone fragments <4 mm on follow-up was regarded as being stone free. The study outcomes included stone-free rates after first, second, and third treatment sessions and stone retropulsion into the kidneys. Results A total of 75 patients each underwent URS and SWL. The mean procedure times for SWL and URS were 61.61± 3.21 and 85.01±6.75 minutes, respectively (P=0.000), and the mean numbers of procedures were 1.51±0.49 and 1.01±0.42, respectively (P=0.000). Stone-free rates after the first, second, and third sessions of SWL were 64%, 77.3%, and 94.7%, respectively, whereas stone-free rates after the first, second, and third sessions of URS were 86.7%, 92%, and 100%, respectively. Rates of stone retropulsion into the kidneys in the SWL and URS groups were 0% and 6.7%, respectively (P=0.000). Conclusion Compared with SWL, URS had significantly higher stone-free rates in patients with proximal ureteral stones. Treatment costs and hospital stay were lower in the SWL group, whereas complication rates were comparable.

Determining whether previous SWL for ureteric stones influences the results of ureteroscopy as the second‑line treatment: A clinical study

“…Although the operative time was decreased, the propensity of higher operative time in patients who received ESWL before URS was also validated by the study conducted by Kilinc et al (18), in which the patients who received URS as a single procedure had a mean operative time of 32 min, while in the other group the mean time was 34 min (18). Ur Rehman et al (14) identified a mean operative duration close to results of the present study, i.e., 85 min for lumbar urolithiasis. Previous findings showed that, the mean operative time on patients treated via URS as first-line therapy was 59 min, while in the second-line URS this was 64 min (19).…”

“…As for larger calculi, such as 20-30 mm, Abe et al (13), on a group of 267 patients, reported a stone-free rate of 65.1% in patients on which SWL was used as a monotherapy. In a recent study, Ur Rehman et al (14) compared the results of SWL and URS in the treatment of lumbar calculi smaller than 20 mm. The authors obtained a stone-free rate of 64% after the first session, 77.3% after the second, and 94.7% after the third session, as for URS the authors had a stone-free rate of 86.7% after the first endoscopic intervention (14).…”

“…In a recent study, Ur Rehman et al (14) compared the results of SWL and URS in the treatment of lumbar calculi smaller than 20 mm. The authors obtained a stone-free rate of 64% after the first session, 77.3% after the second, and 94.7% after the third session, as for URS the authors had a stone-free rate of 86.7% after the first endoscopic intervention (14). Partially contradictory, on a cohort of 657 patients with pelvic urolithiasis (10-15 mm), Dell'Atti and Papa (15) reported stone-free rates of 77.5% with retrograde URS and 45.4% with ESWL only.…”

“…The hypothesis of the negative influence that ESWL may have on the results of URS regarding the stone-free rate was also refuted by Kilinc et al (18), who, on a cohort of 555 patients, found a stone-free rate of 81.25% on patients who received URS as first-line treatment, while on patients who previously received lithotripsy, the rate was 78.75% (P<0.05) (18). Furthermore, recent findings suggested that if the first lithotripsy session fails, the endoscopic management of the pathology must be considered, especially when it is proximal urolithiasis and the size of the calculus exceeds the 10-mm threshold (14). Regarding the surgical time, we found that for patients who received URS as a first-line treatment, the mean operative time was 65 min, and in Group B the mean operative time was 12.2% higher, namely 74.9 min.…”

A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size

“…After reviewing all the original texts, 18 articles were identified as relevant for current meta-analysis (Figure 1) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”