Extracorporeal Shock Wave Lithotripsy verus Rigid Ureteroscopy in Treatment of Mid-Ureteric Stones; Randomized Prospective Study

Abstract

Background Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract is a major health problem due to its high prevalence, incidence and recurrence. The lifetime incidence of kidney stones for men and women is approximately 13% and 7% respectively. Although stones may be asymptomatic, potential consequences include abdominal and flank pain, nausea and vomiting, urinary tract obstruction, infection, and procedure-related morbidity. Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Objectives A prospective randomized study to compare between extracorporeal shock-wave lithotripsy and rigid ureteroscopy in mid-ureteric stone treatment regarding efficacy, stone-free rate, retreatment rates, associated complications (intra-operative and post-operative), operative duration, hospital stay. Patients and Methods This study was performed at Ain Shams University (Urology department) and El Doaah hospital (Urology department), From August 2016 to August 2017, a total of 50 patients having solitary radiopaque middle ureteral stone ranges between 0.5 – 1.5 in size were divided into two groups 25 patients each enrolled in our prospective study. Results In this study the overall stone free rate was considered after two sessions of ESWL (in case of ESWL group) or one trial of ureteroscopy (in case of URS group). ESWL group: 14 cases became stone free after the first session, while the remaining 11 out of 25 patients needed second session, 6 cases became stone free after the second session. ESWL failure occurred in 5 cases and they were successfully managed by ureteroscopy. URS group: 23 cases became stone free after first ureteroscopy, while the remaining 2 patients needed second ureteroscopy due to proximal migration of the stone. In ESWL group, patients were already at outpatient clinic so there were no admission or hospital stay, all cases done without anesthesia, just analgesic ± sedation. While in URS group patients admitted and the hospital stay varies from one day to seven days according to the condition of the case, all URS cases had Spinal anesthesia. ESWL was shown to be less time consuming than URS with a mean operative time of 46.84±3.61 minutes versus 56.20±7.11 minutes respectively. In URS group there were 22 patients had ureteric catheter inserted for 24 to 72 hours postoperatively and 3 patients had double (J) stent inserted for 4 weeks postoperatively, while all the patients who underwent ESWL, no auxiliary procedure done as this procedure is completely non-invasive. Among ESWL cases, No case had an intra-operative complication, while URS group had 3 cases of intra-operative complication. There were 4 cases who had post-operative complications among ESWL group, while there were 5 cases who had post-operative complications among URS group. Conclusion In treatment of mid-ureteral stones range 0.5-1.5 in size, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone free rate and it provides immediate stone clearance with lower re-treatment rates and higher patient satisfaction, but URS requires anesthesia, longer hospitalization, and associated with a higher incidence of complications.