A comparative study between laser ureteroscopy versus extracorporeal shock wave lithotripsy for treatment of upper ureteric stones

Hassona, Mohammed; Teama, Khaled; Radwan, Ahmed; Mostafa, Diaa; Soliman, Mohamed Hassan Ali; Gamal, Mohamed A.

doi:10.4103/ejs.ejs_166_22

A comparative study between laser ureteroscopy versus extracorporeal shock wave lithotripsy for treatment of upper ureteric stones

Authors

Abstract

Objective
The purpose of this study was to compare the efficacy of extracorporeal shock wave lithotripsy (ESWL) versus laser ureteroscopy (URS) in the treatment of upper ureteral stones less than or equal to 1 cm.
Patients and methods
In our Ain Shams University Hospitals, we treated 90 patients aged 18–80 years with upper ureteric stones measuring from 6 mm up to 1 cm by computed tomography urinary tract. Patients were randomly divided into two groups: group A (45 patients) underwent laser URS, which was divided into two subgroups (A1: 22 patients had flexible URS and A2: 23 patients had rigid URS), and group B (45 patients), which underwent ESWL.
Results
The stone-free rate (SFR) was 38/45 (84.4%) in group A and 25/45 (55.6%) in group B (=0.006) after the first session of ESWL, was 33/45 (73.3%) (=0.303) after the second session, and was 35/45 (77.8%) (=0.596) after the third session. A total of seven auxiliary procedures in group A and 10 in group B were needed to reach a 100% SFR (=0.014). Group A had significantly longer operative time, hospital stay, and need for Double J (DJ) application than group B (=0.028, 0.001, and 0.046, respectively). There were no significant differences between the two groups for the number of complicated cases, patient characteristics, or stone characteristics (=0.65, 0.23, 0.77, and 0.62, respectively).
Conclusion
Both ESWL and Holmium laser lithotripsy (flexible and rigid URS) for upper ureteric stones had a high SFR and a low incidence of complications. Holmium laser lithotripsy had higher initial stone rate than ESWL, which becomes comparable with repeated sessions of ESWL, but with longer hospital stay time, higher cost, and higher need for anesthesia. However, ESWL is still accepted as a practical and noninvasive first-line treatment method in the majority of cases because of its high success rates with advantage of outpatient procedure with no need of anesthesia.

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