A group of researchers led by Tamsin Drake conducted a systematic review on the benefits and harms of extracorporeal shockwave lithotripsy and ureteroscopy in the management of proximal ureteral stones. Both procedures were found to be safe and effective, each with its own merits.
Ureteral stones formed from excess minerals and salts are found in the ureter, a tube connecting the kidney to the bladder. Patients usually present with flank pain radiating to the groin, pain upon urination, and blood in the urine. Usually, small stones pass spontaneously. However, bigger stones and stones located at the proximal ureter often require medical management. Extracorporeal shockwave lithotripsy and ureteroscopy are the most common procedures for the management of this condition. Numerous studies comparing the benefits and safety of these procedures have yielded conflicting results.
In a recent article published in European Urology, a group of researchers led by Tamsin Drake performed a systematic literature review regarding the benefits and harms of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in the treatment of proximal ureteric stones. A total of 47 randomized control, quasi-randomized control, and non-randomized trials published between January 2000 to November 2014 were selected from Medline, Embase and Cochrane Library Database for review. The following outcomes were assessed: stone-free rate, presence of complications, retreatment rate (need for additional SWL and URS sessions), and the need for additional secondary procedures.
The results of the literature review indicate that both procedures are safe and effective options for the treatment of proximal ureteral stones. The use of ureteroscopy in the management of proximal ureteral stones is associated with a higher stone-free rate and a lower retreatment rate compared to extracorporeal shockwave lithotripsy. However, it was also found to be associated with longer hospital stays, higher need for additional secondary procedures, and higher complication rates. The benefits and harms of each procedure should be properly explained to patients so they can choose the best option depending on their individual preferences and needs.
Written By: Karla Sevilla