Gong Z. et al., 2023: Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones
Department of Urology, Shengjing Hospital of China Medical University, Shenyang.
Business School Manchester Metropolitan University, Manchester.
Department of Endoscopy, The First Affiliated Hospital of China Medical University, Shenyang.
Department of Urology, Shengjing Hospital of China Medical University, Shenyang.
Department of Urology, Shengjing Hospital of China Medical University, Shenyang.
Abstract
The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%, P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%, P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%, P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%, P = 0.019). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB; P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.
Urolithiasis. 2023 Jun 5;51(1):86. doi: 10.1007/s00240-023-01460-4. PMID: 37272997
Comments 1
The authors have carried out what they describe as a prospective comparison between SWL and URS for treating distal ureteral stones. Exactly how the authors define “prospective” is not known, but in my mind this study is retrospective, albeit with propensity score matching.
Whereas SWL was carried out without sedation or anesthesia, all URS procedures were completed with general anesthesia. It is, however, not fully understood what the authors mean by “treatment…necessary to manage pain and patients’ respiratory excursions and pain-induced patient movements”.
There were no important differences in treatment results apart from URS-caused ureteral injury. Very important is, however, the much higher treatment cost associated with endoscopic treatment. The latter observation is in line with several recent reports.
Hans-Göran Tiselius