Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic

Abstract

Purpose To compare the effectiveness, safety, and cost between ultrasound-guided shock wave lithotripsy (SWL) with an early second session protocol and ureteroscopy (URS) in patients with proximal ureteral stones using the propensity score matching (PSM) method based on a large prospective study. Methods This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or URS) for proximal ureteral stones were enrolled. The stone-free rate (SFR), complications, and cost were recorded. PSM analysis was performed. Results A total of 1230 patients were included, of whom 81.1% (998) were treated with SWL and 18.9% (232) were treated with URS. After PSM, the SWL group had an equivalent SFR at one month (88.7 vs. 83.6%, P = 0.114) compared with the URS group. Complications were rare and comparable between the two groups, while the incidence of ureteral injuries was higher in the URS group compared with the SWL group (1.4 vs. 0%, P = 0.011). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001), and the cost was considerably less (2000 vs. 25,053, P < 0.001) in the SWL group compared with the URS group. Conclusion This prospective PSM cohort demonstrated that ultrasound-guided SWL with an early second session protocol had equivalent effectiveness but better safety and lower cost compared with URS in the treatment of patients with proximal ureteral stones, whether the stones were radiopaque or radiolucent. These results will facilitate treatment decisions for proximal ureteral stones. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-023-04307-0.

Extracorporeal Shockwave Lithotripsy versus Ureteroscopic Laser Lithotripsy in Proximal Ureteric Calculus of 10 to 20 mm in Size: A single centre experience

“…Although, our findings are like other studies in the past, which have shown higher complication rates with URS in comparison to ESWL. Rate of post-op fever was higher (22 %) among our cohort of patients compared to those in past studies, which ranges between 3.5-7 % [6,7,12]. The higher prevalence of diabetes mellitus among our cohort of patients, 62.5 % among URS groups could have attributed to the higher rates of post-op fever in this study.…”

“…The study included only patients with stone density of <1000HU and patients with BMI less than 31 kg/m 2 . Our study results differ from that study, as we have included all patients with stone diameter between 10 to 20 mm in the proximal ureter with no exclusion by stone density or BMI of the patient [12]. In another study, Kumar et al reported that URS has a higher efficacy compared to ESWL despite a 78.4 % of re-treatment rate among the ESWL group for 10-20 mm calculus in the proximal ureter.…”

Extracorporeal Shockwave Lithotripsy versus Ureteroscopic Laser Lithotripsy in Proximal Ureteric Calculus 10 to 20mm in Size Running head: ESWL vs URS in proximal ureteric calculus 10-20mm

“…Rate of post-op fever was higher (22%) among our cohort of patients compared to those in past studies which ranges between 3.5-7%. 6,7,12 The higher prevalence of diabetic mellitus among our cohort of patients 62.5% among URS groups could have been attributed to the higher rates of post-op fever in this study. Rates of urinary tract infection post ureteroscopic lithotripsy are known to be high among diabetic patients.…”

“…Our study results differ from that study, as we have included all patients with stone diameter between 10mm to 20mm in the proximal ureter with no exclusion by stone density or BMI of the patient. 12 In another study, Kumar et al reported URS has a higher e cacy compared to ESWL despite a 78.4% of re-treatment rate among the ESWL group for 1-2cm calculus in the proximal ureter.…”