Objectives: To evaluate the efficacy of flexible ureterscopy (fURS) and extracorporal shockwave lithotripsy (SWL) in the treatment of urolithiasis, complemented by a subgroup analysis of lower pole calyx. Methods: Retrospective analysis of patients treated by fURS or SWL was performed by independent variables such as gender, age, nephrolith size, double-J stent (DJ stent) and stone localisation. Results: Out of 326 patients, 165 were treated by SWL and 161 by fURS. Complete stone removal was achieved by fURS in 83.2% and by SWL in 43.0% (p < 0.001). Asymptomatic behaviour (88-89%) and complication rate (10-11%) were nearly the same in both methods. A higher retreatment rate for SWL was necessary; otherwise, an auxillary DJ stent was performed more often preoperative before fURS. The subgroup analysis of lower pole calyx confirmed these evaluations. Conclusions: Complete stone-free removal was almost 8 times higher after fURS compared to SWL. The efficacy of fURS in treatment of urolithiasis is substantially higher than the efficacy of SWL.

Keywords:
SWL, Stone free, Complication, fURS, Urolithiasis, Lower pole calyx
1.
Miller OF, Kane CJ: Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 1999;162(3 pt 1):688-690; discussion 690-691.
2.
Galvin DJ, Pearle MS: The contemporary management of renal and ureteric calculi. BJU Int 2006;98:1283-1288.
3.
Preminger GM, Tiselius HG, Assimos DG, et al: American Urological Association Education and Research, Inc; European Association of Urology. Guideline for the management of ureteral calculi. Eur Urol 2007;52:1610-1631.
4.
Tiselius HG: How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol 2008;22:249-255.
5.
Elashry OM, Elgamasy AK, Sabaa MA, et al: Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int 2008;102:1010-1017.
6.
Wendt-Nordahl G, Mut T, Krombach P, et al: Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011;39:185-188.
7.
Buscarini M, Conlin M: Update on flexible ureteroscopy. Urol Int 2008;80:1-7.
8.
Argyropoulos AN, Tolley DA: Evaluation of outcome following lithotripsy. Curr Opin Urol 2010;20:154-158.
9.
Srisubat A, Potisat S, Lojanapiwat B, et al: Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2009;7:CD007044.
10.
Sahinkanat T, Ekerbicer H, Onal B: Evaluation of the effects of relationships between main spatial lower pole calyceal anatomic factors on the success of shock-wave lithotripsy in patients with lower pole kidney stones. Urology 2008;71:801-805.
11.
Danuser H, Müller R, Descoeudres B, et al: Extracorporeal shock wave lithotripsy of lower calyx calculi: how much is treatment outcome influenced by the anatomy of the collecting system? Eur Urol 2007;52:539-546.
12.
Türk C, Koll T, Petrik A, et al: Guidelines on Urolithiasis. European Association of Urology, 2012, pp 22-25.
13.
Sener NC, Bas O, Sener E, et al: Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology 2015;85:33-37.
14.
Hübner W, Porpaczy P: Treatment of caliceal calculi. Br J Urol 1990;66:9-11.
15.
Preminger GM, Tiselius HG, Assimos DG, et al: EAU/AUA nephrolithiasis guideline panel. Guidelines on urolithiasis. J Urol 2007;178:2418-2434.
16.
Ather MH, Shrestha B, Mehmood A: Does ureteral stenting prior to shock wave lithotripsy influence the need for intervention in steinstrasse and related complications. Urol Int 2009;83:222-225.
17.
Skolarikos A, Alivizatos G, de la Rosette J: Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 2006;50:981-990; discussion 990.
18.
Geavlete P, Georgescu D, Niţă G, et al: Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006;20:179-185.
19.
Perez Castro E, Osther PJ, Jinga V, et al: Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 2014;66:102-109.
20.
Musa AA: Use of double-J stents prior to extracorporeal shock wave lithotripsy is not beneficial: results of a prospective randomized study. Int Urol Nephrol 2008;40:19-22.
21.
Mohayuddin N, Malik HA, Hussain M, et al: The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent - a comparative study. J Pak Med Assoc 2009;59:143-146.
22.
Seklehner S, Heißler O, Engelhardt PF, et al: Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi? Urol Int 2015;94:166-172.
23.
Rubenstein RA, Zhao LC, Loeb S, et al: Prestenting improves ureteroscopic stone-free rates. J Endourol 2007;21:1277-1280.
24.
Song T, Liao B, Zheng S, Wei Q: Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Urol Res 2012;40:67-77.
25.
Haleblian G, Kijvikai K, de la Rosette J, Preminger G: Ureteral stenting and urinary stone management: a systematic review. J Urol 2008;179:424-430.
26.
Nabi G, Cook J, N'Dow J, McClinton S: Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007;334:572.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.