Extracorporeal Shockwave Lithotripsy versus Ureteroscopy: A First Line Distal Ureteric Stone Treatment

Abstract

Background: Despite the emergence of many novel minimally invasive techniques including percutaneous nephrolithotomy, ureteroscopy, extracorporeal shock wave lithotripsy, many urologists still prefer open surgery for the management of ureteric stones. The present study compared the efficacy of extracorporeal shockwave lithotripsy (ESWL) with ureteroscopy (URS) for the treatment of distal ureteral calculi.

Methods: A single-blinded, randomized controlled trial, which was conducted between January 2018 to June 2019 at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan. All patients diagnosed with unilateral, solitary, and distal ureteral stones were randomized in two groups. The patients in Group A underwent with ESWL and group B underwent ureteroscopy. The outcome of procedures was assessed after 3 months. Data was analyzed via Statistical Package for the Social Sciences (SPSS version 25). Chi-squared test was applied to compare the clinical efficacy of both techniques. A p<0.05 was considered as statistically significant.

Results: Out of 106 patients, majority were females n=61(58%). Overall, the mean age of population was 41.9 ± 10.4 years, and the mean stone size was 13.1 ± 4.3 mm. Both the groups were almost comparable with respect to age and size of stones. There was a significant difference in outcome of both the procedures, as the residual stones were more in ESWL and URS i.e., 64.0% vs. 33.9% (p=0.019).

Conclusion: In hospitals, both of the techniques are suitable for treatment purpose. However, the present results suggest that URS is a more effective procedure than ESWL (p=0.019) for treating ureteral stones and should be utilized as the first-line treatment for distal ureteral calculi.

Keywords: Lithotripsy; Ureteroscopy; Ureteral Calculi.