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Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi.
Int J Clin Pract. 2007 May; 61(5):784-8.IJ

Abstract

There is controversy over whether shock wave lithotripsy (SWL) or ureteroscopy (URS) is the best management of ureteric calculi, especially for stones located in the upper ureter. This study compares URS and SWL management of upper ureteric stones directly for the first time using a different analysis tool, the matched pair analysis study design. This method enables meaningful comparisons to be made on a small number of matched patients, using precise like-for-like matching. Adult patients undergoing primary treatment of solitary radiopaque proximal ureteric stones were identified. Patients with stents, nephrostomies or stones at the pelvi-ureteric junction were excluded. Patients had a minimum of 3 months follow-up. Patients treated by primary URS were matched using four parameters (sex, laterality, stone size and location) to patients treated on a Dornier Compact Delta Lithotriptor. A total of 1479 patients had URS or SWL from which 27 upper ureteric stone matched pairs were identified. Three-month stone free rates were 82% for URS and 89% for SWL (McNemar's test, p=0.625). Re-treatment was required in 11% and 26% following URS and SWL respectively (p=0.219). Forty-one per cent of URS patients required an ancillary treatment, such as stent removal, compared with only 22% of SWL patients (p=0.227). Introduction of a holmium:YAG laser for use with URS improved the stone free rate for URS to 100%. Using a robust like-for-like comparison of similar patients with very similar upper ureteric stones the outcomes following SWL and URS were comparable. Choice of treatment should therefore be based on parameters such as availability of equipment, waiting times and patient preference.

Authors+Show Affiliations

The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17386062

Citation

Stewart, G D., et al. "Matched Pair Analysis of Ureteroscopy Vs. Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi." International Journal of Clinical Practice, vol. 61, no. 5, 2007, pp. 784-8.
Stewart GD, Bariol SV, Moussa SA, et al. Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi. Int J Clin Pract. 2007;61(5):784-8.
Stewart, G. D., Bariol, S. V., Moussa, S. A., Smith, G., & Tolley, D. A. (2007). Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi. International Journal of Clinical Practice, 61(5), 784-8.
Stewart GD, et al. Matched Pair Analysis of Ureteroscopy Vs. Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi. Int J Clin Pract. 2007;61(5):784-8. PubMed PMID: 17386062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi. AU - Stewart,G D, AU - Bariol,S V, AU - Moussa,S A, AU - Smith,G, AU - Tolley,D A, Y1 - 2007/03/26/ PY - 2007/3/28/pubmed PY - 2007/8/25/medline PY - 2007/3/28/entrez SP - 784 EP - 8 JF - International journal of clinical practice JO - Int J Clin Pract VL - 61 IS - 5 N2 - There is controversy over whether shock wave lithotripsy (SWL) or ureteroscopy (URS) is the best management of ureteric calculi, especially for stones located in the upper ureter. This study compares URS and SWL management of upper ureteric stones directly for the first time using a different analysis tool, the matched pair analysis study design. This method enables meaningful comparisons to be made on a small number of matched patients, using precise like-for-like matching. Adult patients undergoing primary treatment of solitary radiopaque proximal ureteric stones were identified. Patients with stents, nephrostomies or stones at the pelvi-ureteric junction were excluded. Patients had a minimum of 3 months follow-up. Patients treated by primary URS were matched using four parameters (sex, laterality, stone size and location) to patients treated on a Dornier Compact Delta Lithotriptor. A total of 1479 patients had URS or SWL from which 27 upper ureteric stone matched pairs were identified. Three-month stone free rates were 82% for URS and 89% for SWL (McNemar's test, p=0.625). Re-treatment was required in 11% and 26% following URS and SWL respectively (p=0.219). Forty-one per cent of URS patients required an ancillary treatment, such as stent removal, compared with only 22% of SWL patients (p=0.227). Introduction of a holmium:YAG laser for use with URS improved the stone free rate for URS to 100%. Using a robust like-for-like comparison of similar patients with very similar upper ureteric stones the outcomes following SWL and URS were comparable. Choice of treatment should therefore be based on parameters such as availability of equipment, waiting times and patient preference. SN - 1368-5031 UR - https://www.unboundmedicine.com/medline/citation/17386062/Matched_pair_analysis_of_ureteroscopy_vs__shock_wave_lithotripsy_for_the_treatment_of_upper_ureteric_calculi_ L2 - https://doi.org/10.1111/j.1742-1241.2007.01296.x DB - PRIME DP - Unbound Medicine ER -