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Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the
treatment of untreated renal calculi
#MMPMID29992018
Fankhauser CD
; Hermanns T
; Lieger L
; Diethelm O
; Umbehr M
; Luginbühl T
; Sulser T
; Müntener M
; Poyet C
Clin Kidney J
2018[Jun]; 11
(3
): 364-369
PMID29992018
show ga
BACKGROUND: The reported success rates for treatments of kidney stones with
either extracorporeal shock wave lithotripsy (ESWL) or flexible ureterorenoscopy
(URS) are conflicting. We aimed to compare the efficacy and safety of ESWL and
URS for previously untreated renal calculi. METHODS: All patients treated with
ESWL or URS at our tertiary care centre between 2003 and 2015 were
retrospectively identified. Patients with previously untreated kidney stones and
a stone diameter of 5-20?mm were included. Stone-free, freedom from
reintervention and complication rates were recorded. Independent predictors of
stone-free and freedom from reintervention rates were identified by multivariable
logistic regression and a propensity score-matched analysis was performed.
RESULTS: A total of 1282 patients met the inclusion criteria, of whom 999 (78%)
underwent ESWL and 283 (22%) had URS. During post-operative follow-up, only
treatment modality and stone size could independently predict stone-free and
freedom from reintervention rates. After propensity score matching, ESWL showed
significantly lower stone-free rates [ESWL (71%) versus URS (84%)] and fewer
patients with freedom from reintervention [ESWL (55%) versus URS (79%)] than URS.
Complications were scarce for both treatments and included Clavien Grade 3a in
0.8% versus 0% and Grade 3b in 0.5% versus 0.4% of ESWL and URS treated patients,
respectively. CONCLUSIONS: Treatment success was mainly dependent on stone size
and treatment modality. URS might be the better treatment option for previously
untreated kidney stones 5-20?mm, with similar morbidity but higher stone-free
rates and fewer reinterventions than ESWL.
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