The effect of stone size on the results of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscopic lithotripsy in the management of upper ureteric stones

IF 1.3 Q3 UROLOGY & NEPHROLOGY

Arab Journal of Urology Pub Date : 2021-11-26 DOI:10.1080/2090598X.2021.1996820

A. El-abd, A. Tawfeek, S. El-Abd, T. Gameel, H. El-Tatawy, Magdy A. El-Sabaa, M. Soliman

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引用次数: 1

Abstract

ABSTRACT Objectives To evaluate the role of stone size on the efficacy and safety of extracorporeal shockwave lithotripsy (ESWL) monotherapy vs ureteroscopy (URS) for managing upper ureteric stones. Patients and methods The study design was a randomised prospective study of a total cohort of 180 patients with upper ureteric single stones of 0.5–1.5 cm. Half of the patients were managed by ESWL monotherapy, while the other half underwent URS with stone fragmentation using an ultrasound lithotripter (URSL). The success rate, re-treatment rate, auxiliary procedure (AP) rate, efficacy quotient, and complications were compared between the two groups. Results After single URSL and ESWL procedures 70/90 (77.8%) and 35/90 (38.9%) of the stones were successfully cleared, respectively (P < 0.001). The re-treatment rate after ESWL was significantly higher than in the URSL group (38.9% vs 11.1%, P < 0.001). Requiring an AP was not significantly different following ESWL (22.2%) and URSL (24.4%) treatment. The overall stone-free rate (SFR) at 3 months was significantly superior in the URSL group (88.9% vs 77.8%); however, both procedures had excellent results with no significant difference for stones of <1 cm (95.5% vs 92.9%, P > 0.05), compared to better results following URSL for stones of >1 cm (82.6% vs 64.6%, P < 0.05). Conclusion Our present study supports that ESWL is recommended as a first-line non-invasive monotherapy for upper ureteric opaque stones of <1 cm, while URSL is recommended as a first-line treatment for stones of >1 cm. The results for URSL were superior with lower a re-treatment rate, rapid stone clearance in a very short time, and less radiation exposure. Therefore, stone size is an important factor for the final decision of the initial management of upper ureteric stones because it has a direct relation to the efficacy of ESWL, but it has no effect on the results of URSL.

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输尿管上段结石的治疗:体外冲击波碎石与半刚性输尿管镜碎石对结石大小的影响

摘要目的评估结石大小对体外冲击波碎石（ESWL）单药治疗与输尿管镜（URS）治疗输尿管上段结石的疗效和安全性的影响。患者和方法该研究设计是一项随机前瞻性研究，共有180名患者患有0.5-1.5 cm的上输尿管单结石。其中一半患者接受ESWL单药治疗，另一半患者使用超声碎石术（URSL）进行输尿管镜碎石术。比较两组的成功率、再治疗率、辅助手术（AP）率、疗效商和并发症。结果单次URSL和ESWL治疗后，结石清除率分别为70/90（77.8%）和35/90（38.9%）（P＜0.001）。ESWL后的再治疗率明显高于URSL组（38.9%和11.1%，P＜0.001。URSL组3个月时的总结石清除率（SFR）显著高于URSL组（88.9%对77.8%）；然而，与URSL治疗>1cm结石的疗效更好（82.6%对64.6%，P＜0.05）相比，两种方法的疗效都很好，对结石的疗效无显著差异（0.05）。结论我们目前的研究支持ESWL作为治疗1cm上输尿管不透明结石的一线非侵入性单一疗法。URSL的结果优越，再次治疗率较低，结石在很短的时间内快速清除，辐射暴露较少。因此，结石大小是最终决定上输尿管结石初始治疗的重要因素，因为它与ESWL的疗效直接相关，但对URSL的结果没有影响。

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来源期刊

Arab Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

2.80

自引率

0.00%

发文量

期刊介绍： The Arab Journal of Urology is a peer-reviewed journal that strives to provide a high standard of research and clinical material to the widest possible urological community worldwide. The journal encompasses all aspects of urology including: urological oncology, urological reconstructive surgery, urodynamics, female urology, pediatric urology, endourology, transplantation, erectile dysfunction, and urinary infections and inflammations. The journal provides reviews, original articles, editorials, surgical techniques, cases reports and correspondence. Urologists, oncologists, pathologists, radiologists and scientists are invited to submit their contributions to make the Arab Journal of Urology a viable international forum for the practical, timely and state-of-the-art clinical urology and basic urological research.