Management Of 10 15 Mm Proximal Ureteral Stones: Ureteroscopy Or Extracorporeal Shockwave Lithotripsy?

Main Category: Urology / Nephrology
Article Date: 20 Apr 2008 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

UroToday.com - In this study, 166 patients with a 10-15 mm proximal ureteral stone, after informed consent, were allowed to choose their own therapy: SWL (Dornier Doli Compact {96} and MPL 9000 {30}) or holmium laser lithotripsy with a semi-rigid ureteroscope {51}. The stone free rate at 3 months (imaging method not stated in the manuscript), was 79% for SWL and 73% for ureteroscopy. Among the SWL patients, 21% underwent auxiliary procedures, it appears that no stents were placed in these patients. Among the ureteroscopy patients, 27% required auxiliary procedures and 48% required an indwelling ureteral stent. Of note, the operative time was only 29 minutes for ureteroscopy and 21 minutes for SWL.

While I am still very much a proponent of SWL, these results are incredibly good. For the ureteroscopy, one wonders whether results would have improved with the use of a flexible ureteroscope. Even then, in our shop we could not compete with SWL operative times of less than 25 minutes. Also, I believe that the gold standard for determining stone free rate in 2008 is a CT urogram, despite objections regarding radiation exposure.

Be that as it may, what makes this study unique is the provision of both options to the patient with the patient making the decision. I am not sure where a study of this nature would stand with regard to evidence based medicine, but it does approach a prospective randomized study in intent although others would raise concerns about physician induced bias in the selection process.

Ziaee SA, Halimiasl P, Aminsharifi A, Shafi H, Beigi FM, Basiri A

Reported by UroToday.com Medical Editor Ralph V. Clayman

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday