Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones

What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review

“…A total of 47 studies were eligible for final inclusion; 22 of these compared URS with SWL. Of these, 18 were full text articles [5,9,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and four were conference abstracts [35][36][37][38].…”

“…Of the 22 final studies comparing SWL with URS, four were RCTs [11,20,21,35], one was a QRCT [22] and 17 [5,9,[23][24][25][26][27][28][29][30][31][32][33][34][36][37][38] were comparative NRSs. Of the final 25 included comparative intragroup (intra-SWL and intra-URS) studies, 24 were full text articles [7,, and one was a conference abstract [62].…”

“…''Stonefree'' was defined for the purposes of this review as no stone fragments remaining at the reported time point. Stone-free status was measured immediately in four studies [11,29,31,33], at 1 wk in one study [20], at 2 wk in two studies [21,22], at 3 wk in one study [9], at 4 wk in four studies [24,25,30,32], at 6 wk in one study [27], at 3 mo in six studies [5,9,24,28,30,35], and was unclear in six studies [23,26,34,[36][37][38]. In three of the studies two different SFR time points were measured within each study [9,24,30].…”

“…The success rates tend to decrease for distal stones, while stones treated in an emergency setting have a high success rate, similar to those treated with delayed lithotripsy [6][7][8][9][10][11][12]. However, the clinical introduction of URS has significantly changed the treatment concepts for ureteral stones.…”

The Future of SWL: A Global Perspective

“…Multiple trials have tried to calculate costs and remuneration for SWL and endourologic procedures, but have not been able to present consistent results. In some studies SWL was more cost effective [53] and in others URS [54][55][56]. Remuneration is determined by the health system and therefore differs significantly with the country [57].…”