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Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones

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Abstract

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%, P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%, P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%, P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%, P = 0.019). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB; P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

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Data availability

All the data were presented in the form of Tables. Patient information was collected from the electronic medical files of our institution. The data are not available and have been used is confidential.

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Acknowledgements

We give special thanks to all the colleagues at the Department of Urology of Shengjing Hospital for their help and support. The authors would like to thank all of the study participants.

Funding

This study was financially supported by The 345 Talent Project of Shengjing Hospital, Natural Science Foundation of Liaoning Science and Technology Department (grant number 2020-BS-093), and Natural Science Foundation of Liaoning Education Department (grant number QN2019013). These sponsors had no role in the study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Author notes

  1. Zheng Gong, Yipeng Li and Huijing Zhang have contribute equally to this work.

Authors and Affiliations

  1. Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People’s Republic of China

    Zheng Gong, Chunyu Pan, Jia Li, Gang Liu & Song Bai

  2. Business School Manchester Metropolitan University, Manchester, M15 6BH, UK

    Yipeng Li

  3. Department of Endoscopy, The First Affiliated Hospital of China Medical University, Shenyang, China

    Huijing Zhang

Authors
  1. Zheng Gong
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  2. Yipeng Li
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  4. Chunyu Pan
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  5. Jia Li
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  6. Gang Liu
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  7. Song Bai
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Contributions

SB: had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SB: Protocol/project development. ZG, YL, HZ, CP, JL, GL, and SB: data collection or management. ZG, and SB: data analysis. ZG, YL, HZ, and SB: manuscript writing/editing/revision.

Corresponding authors

Correspondence to Gang Liu or Song Bai.

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Conflict of interest

The authors (Zheng Gong, Yipeng Li, Huijing Zhang, Chunyu Pan, Jia Li, Gang Liu, and Song Bai) declare that they have no competing interests.

Ethical approval

Ethical approval (2020PS520K) was provided by the Ethics Committee of Shengjing Hospital Affiliated China Medical University. Informed consent from all eligible subjects was obtained.

Consent for publication

Informed consent from all eligible patients was obtained.

Study registration

The clinical research registry UIN is ChiCTR2000033790 (http://www.chictr.org.cn/index.aspx). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.

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Gong, Z., Li, Y., Zhang, H. et al. Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones. Urolithiasis 51, 86 (2023). https://doi.org/10.1007/s00240-023-01460-4

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