Extracorporeal shockwave lithotripsy versus ureteroscopy for 5- to 10-mm stones in the proximal ureter: Prospective effectiveness patient-preference trial.
BACKGROUND
To establish the best treatment modality in our hospitals for patients with proximal-ureteral calculi 5 to 10 mm, we compared the treatment outcome in those who underwent primary ureteroscopy (URS) with that in patients who underwent primary in-situ SWL. The primary endpoints were stone-free rates at 3 weeks and 3 months and the subjective patient experience.


METHODS
The study was a prospective patient-preference trial. From September 2002 to May 2005, 80 patients were included, of whom 71 could be evaluated. Thirty-three patients were treated with SWL and 38 with semirigid or flexible URS. Stone status was evaluated with excretory urography or noncontrast helical CT. The bother score of urinary-tract symptoms was recorded on a visual analog scale.


RESULTS
The stone-free rate at 3 weeks was 58% and 78% (P = 0.061) and at 3 months 88% and 89% (P = 1) for SWL and URS, respectively. The percentage of patients in need of analgesics was 30% and 49% (P = 0.118) at 3 weeks and 9% and 21% (P = 0.181) at 3 months for the SWL and the URS group, respectively. The bother score regarding dysuria, hematuria, and flank pain were statistically significant in favor of SWL.


CONCLUSIONS
Ureteroscopy tends to make patients stone free faster, but SWL is preferred by most patients because there is less discomfort after treatment.
Karlsen
Steinar J
SJ
University of Oslo, Oslo Urological University Clinic, Aker University Hospital, Oslo, Norway. steinar.karlsen@medisin.uio.no
Renkel
Julian
J
Tahir
Abdul R
AR
Angelsen
Anders
A
Diep
Lien M
LM
D000328:Adult; D000368:Aged; D000700:Analgesics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy
D000700:Analgesics