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A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience.
J Endourol 2015; 29(1):47-51JE

Abstract

BACKGROUND AND PURPOSE

The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures.

PATIENTS AND METHODS

Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications.

RESULTS

There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21).

CONCLUSIONS

Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.

Authors+Show Affiliations

Department of Urology, Vardhman Mahaveer Medical College and Safdarjang Hospital , New Delhi, India .No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

23914770

Citation

Kumar, Anup, et al. "A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones <2 Cm: a Single Center Experience." Journal of Endourology, vol. 29, no. 1, 2015, pp. 47-51.
Kumar A, Nanda B, Kumar N, et al. A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience. J Endourol. 2015;29(1):47-51.
Kumar, A., Nanda, B., Kumar, N., Kumar, R., Vasudeva, P., & Mohanty, N. K. (2015). A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience. Journal of Endourology, 29(1), pp. 47-51. doi:10.1089/end.2012.0493.
Kumar A, et al. A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones <2 Cm: a Single Center Experience. J Endourol. 2015;29(1):47-51. PubMed PMID: 23914770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience. AU - Kumar,Anup, AU - Nanda,Biswajit, AU - Kumar,Niraj, AU - Kumar,Rohit, AU - Vasudeva,Pawan, AU - Mohanty,Nayan K, PY - 2013/8/7/entrez PY - 2013/8/7/pubmed PY - 2015/7/22/medline SP - 47 EP - 51 JF - Journal of endourology JO - J. Endourol. VL - 29 IS - 1 N2 - BACKGROUND AND PURPOSE: The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures. PATIENTS AND METHODS: Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. RESULTS: There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21). CONCLUSIONS: Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/23914770/A_prospective_randomized_comparison_between_shockwave_lithotripsy_and_semirigid_ureteroscopy_for_upper_ureteral_stones_<2_cm:_a_single_center_experience_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2012.0493?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -