Bai S. et al., 2023: Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non-lower pole kidney stones under the COVID-19 pandemic
Bai S, Zhan Y, Pan C, Liu G, Li J, Shan L.
Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China.
Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China.
Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China.
Abstract
Both shock wave lithotripsy (SWL) and flexible ureterorenoscopy (F-URS) are recommended as the first choice for non-lower pole kidney stones. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of SWL versus F-URS in patients with solitary non-lower pole kidney stones ≤ 20 mm under the COVID-19 pandemic. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or F-URS) for non-lower pole kidney stones were enrolled in this study. The stone-free rate (SFR), retreatment rate, complications, and cost were recorded. Propensity score-matched (PSM) analysis was performed. A total of 699 patients were finally included, of which 81.3% (568) were treated with SWL and 18.7% (131) underwent F-URS. After PSM, SWL showed equivalent SFR (87.9% vs. 91.1%, P = 0.323), retreatment rate (8.6% vs. 4.8%, P = 0.169), and adjunctive procedure (2.6% vs. 4.9%, P = 0.385) compared with F-URS. Complications were scarce and also comparable between SWL and F-URS (6.0% vs 7.7%, P > 0.05), while the incidence of ureteral perforation was higher in the F-URS group compared with the SWL group (1.5% vs 0%, P = 0.008). The hospital stay was significantly shorter (1 day vs 2 days, P < 0.001), and the cost was considerably less (1200 vs 30,083, P < 0.001) in the SWL group compared with the F-URS group. This prospective cohort demonstrated that SWL had equivalent efficacy with more safety and cost benefits than F-URS in treating patients with solitary non-lower pole kidney stones ≤ 20 mm. During the COVID-19 pandemic, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS. These findings may guide clinical practice.
Urolithiasis. 2023 Feb 16;51(1):38. doi: 10.1007/s00240-023-01412-y. PMID: 36795174. FREE ARTICLE
Comments 1
A very busy department (1,2,3).
Are the results not very good indeed?
“The stone-free rate (SFR) was defined as no evidence of clinically significant stone fragments (≥ 4 mm in size) in combination with a plain X-ray of the urinary tract (KUB) and urinary ultrasound one month after SWL or F-URS. The complete stone-free rate (SFR) was defined as no evidence of any stone fragments in combination with a plain X-ray of the urinary tract (KUB) and urinary ultrasound one month after SWL or F-URS. Retreatment was defined as any subsequent intervention performed for the residual stones beyond the initial preplanned modality. For F-URS, include more than one F-URS session or need for a secondary intervention (e.g., percutaneous nephrolithotomy [PCNL] or SWL). For SWL, include more than one SWL session or need for a secondary intervention (e.g., F-URS or PCNL). Adjunctive procedures were defined as procedures needed to deal with a postoperative complication of the primary treatment (e.g., JJ stent or nephrostomy placement).”
1 Bai S, Zhan Y, Pan C, Liu G, Li J, Shan L.
Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non-lower pole kidney stones under the COVID-19 pandemic.
Urolithiasis. 2023 Feb 16;51(1):38. doi: 10.1007/s00240-023-01412-y.PMID: 36795174
Free PMC article.
2 Yin X, Li J, Pan C, Liu G, Li Z, Bai S.
Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort.
World J Urol. 2023 Mar 13. doi: 10.1007/s00345-023-04358-3. Online ahead of print.PMID: 36912972
3 Na L, Li J, Pan C, Zhan Y, Bai S.
Development and validation of a predictive model for major complications after extracorporeal shockwave lithotripsy in patients with ureteral stones: based on a large prospective cohort.
Urolithiasis. 2023 Mar 2;51(1):42. doi: 10.1007/s00240-023-01417-7.PMID: 36862228
Free PMC article.
Peter Alken