Abstract
We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.
Highlights
Urinary lithiasis can cause a greater or lesser degree of obstruction of the lower ureter, depending on the size of the calculus, urothelial edema and the degree of impaction, requiring instrumental treatment, sometimes as an urgent procedure
The indications for ureteroscopic lithotripsy have increased with smaller semi-rigid ureteroscopes and reliable laser technology and the production of more robust flexible instruments has further expanded the indications for endoscopic intervention
4 patients (4.3%) required pre-extracorporeal shockwave lithotripsy (ESWL) double pigtail stents for persistent ureteric colic not responding to conservative treatment
Summary
Urinary lithiasis can cause a greater or lesser degree of obstruction of the lower ureter, depending on the size of the calculus, urothelial edema and the degree of impaction, requiring instrumental treatment, sometimes as an urgent procedure. Advances in the design of the ureteroscope and ongoing development in ESWL have greatly impacted the management of ureteric stones [5]. ESWL and URS are currently accepted treatment modalities for distal ureteral calculi. Some authors [6,7] favor ESWL while others [8,9,10] prefer URS For both treatment modalities stone-free rates of more than 90% have been reported [7,9,10]. The American Urological Association Ureteral Stones Clinical Guidelines Panel has found both to be acceptable treatment options for patients, based on the stone-free results, morbidity, and retreatment rates for each respective therapy. We aim to compare the efficacy and safety of ESWL and URS for distal ureteral calculi with respect to patient satisfaction
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