Efficiency and cost of treating proximal ureteral stones: Shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser

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].…”

“…1, achievement of stone-free status favouring URS reached statistical significance in nine studies [22,24,25,[29][30][31][32][33]36] of which four were significant at 4 wk [24,25,30,32]. In the remaining 13 studies [5,9,11,20,21,23,[26][27][28]34,35,37,38] no significant difference was found between SWL and URS for the treatment of proximal ureteric stones.…”

“…In all but one of these studies [20] (which subdivided stones into those 12 mm and > 12 mm), this breakdown consisted of stones >10 mm and stones <10 mm. With regards to >10 mm sized stones, five studies showed SFR to be superior with URS [20,26,29,31,33], whilst four studies [22,27,28,35] showed no difference. For the smaller stones (17) 18 (9) 0.4570 AP = adjunctive procedure; CA = cost analysis; CG = Clavien Grade; CIRFR = clinically insignificant residual fragment; CIRFR-B = clinically insignificant residual fragment at time point B (time point B being stated within parentheses in mo, but only up to 3 mo); Com = comparator; CR = complication rate; DHS = duration of hospital stay; DP = duration of procedure; EDV = emergency department visit; HR = hospital readmission; HER = haematuria; n = number of; N/A = not applicable; NR = not reported; NS = insignificant p value; MU = mid ureter; QOL = quality of life; Pain: use of painkillers (as specified by study authors); RCT = randomised controlled trial; RO = radio-opaque; RTR = retreatment rate; SFR = stone free rate; SFR-B = SFR at time point B (time point B being stated within parentheses in mo, but only up to 3 mo); SP = secondary procedure; STER = steinstrasse; SWL = shock-wave lithotripsy; TCC = time to complete clearance; Treat = treatment; UI = ureteric injury; URS = ureteroscopy; UU = upper ureter; VAS = visual analogue scale; VS = voiding symptoms.…”