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

Ahmed S El-Abd; Ahmed M Tawfeek; Shawky A El-Abd; Tarik A Gameel; Hasan H El-Tatawy; Magdy A El-Sabaa; Mohamed G Soliman

doi:10.1080/2090598X.2021.1996820

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

Arab J Urol. 2021 Nov 26;20(1):30-35. doi: 10.1080/2090598X.2021.1996820. eCollection 2022.

Authors

Ahmed S El-Abd¹, Ahmed M Tawfeek¹, Shawky A El-Abd¹, Tarik A Gameel¹, Hasan H El-Tatawy¹, Magdy A El-Sabaa¹, Mohamed G Soliman¹

Affiliation

¹ Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

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.

Keywords: Stones; extracorporeal shockwave lithotripsy; ureteroscopy.