Abstract
In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Doddamani D, Sinha T (2011) Efficacy of flexible fibreoptic ureteroscopy and Holmium laser in retrograde intrarenal surgery for calyceal calculi. Med J Armed Forces India 67:217–220. doi:10.1016/S0377-1237(11)60044-0
Turk C, Knoll T, Petrik A et al (2013) European association of urology. Guidelines on urolithiasis
Jung H, Nørby B, Osther PJ (2006) Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones. Scand J Urol Nephrol 40:380–384. doi:10.1080/00365590600679269
Hautmann S, Friedrich MG, Fernandez S et al (2004) Extracorporeal shockwave lithotripsy compared with ureteroscopy for the removal of small distal ureteral stones. Urol Int 73:238–243
Ilker Y, Tarcan T, Akdas A (1995) When should one perform shockwave lithotripsy for lower calyceal stones? J Endourol Endourol Soc 9:439–441
El-Assmy A, El-Nahas AR, Abo-Elghar ME et al (2006) Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for renal calculi between 20 and 30 mm: a multivariate analysis model. Sci World J 6:2388–2395. doi:10.1100/tsw.2006.370
Danuser H, Müller R, Descoeudres B et al (2007) Extracorporeal shock wave lithotripsy of lower calyx calculi: how much is treatment outcome influenced by the anatomy of the collecting system? Eur Urol 52:539–546. doi:10.1016/j.eururo.2007.03.058
Lin C-C, Hsu Y-S, Chen K-K (2008) Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy. J Chin Med Assoc JCMA 71:496–501. doi:10.1016/S1726-4901(08)70157-6
D’Addessi A, Vittori M, Racioppi M et al (2012) Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them—a review. Sci World J 2012:619820. doi:10.1100/2012/619820
Wirth MP, Theiss M, Frohmüller HG (1992) Primary extracorporeal shock wave lithotripsy of staghorn renal calculi. Urol Int 48:71–75
Bierkens AF, Hendrikx AJ, Lemmens WA, Debruyne FM (1991) Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial. J Urol 145:699–702
Dhar NB, Thornton J, Karafa MT, Streem SB (2004) A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 172:2271–2274
Grasso M, Ficazzola M (1999) Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol 162:1904–1908
Wen CC, Nakada SY (2007) Treatment selection and outcomes: renal calculi. Urol Clin North Am 34:409–419. doi:10.1016/j.ucl.2007.04.005
Tawfiek ER, Bagley DH (1999) Management of upper urinary tract calculi with ureteroscopic techniques. Urology 53:25–31
Hollenbeck BK, Schuster TG, Faerber GJ, Wolf JS (2001) Flexible ureteroscopy in conjunction with in situ lithotripsy for lower pole calculi. Urology 58:859–863
Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS (2002) Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ and after displacement. J Urol 168:43–45
Pearle MS, Lingeman JE, Leveillee R et al (2005) Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 173:2005–2009. doi:10.1097/01.ju.0000158458.51706.56
Geavlete P, Georgescu D, Niţă G et al (2006) Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol Endourol Soc 20:179–185
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ (2012) Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int 110:898–902. doi:10.1111/j.1464-410X.2012.10961.x
Conflict of interest
All the authors declare that there is no conflict of interest with any financial organization.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sener, N.C., Abdurrahim Imamoglu, M., Bas, O. et al. Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm. Urolithiasis 42, 127–131 (2014). https://doi.org/10.1007/s00240-013-0618-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-013-0618-z