title: Does previous failed ESWL have a negative impact of on the outcome of ureterorenoscopy? A matched pair analysis.
abstract: This study aims to evaluate the outcome of ureteroscopy/ureterorenoscopy (URS) as a salvage procedure for stones resistant to extracorporeal shock wave lithotripsy (ESWL). Between January 2009 and January 2012, 313 patients with upper tract lithiasis were treated by URS. Among them, 87 (27.8 %) had undergone URS after prior ESWL failed to achieve stone clearance (Salvage group). These patients were matched with a group of patients who underwent URS as first-line modality (Primary group). Stone-free rates and adjuvant procedures represented the primary points for comparison. Secondary points for comparison included complications, procedure duration, total laser energy used and length of hospitalization. Matching was possible in all cases. Stone clearance rates were 73.6 and 82.8 % for the Salvage and Primary group, respectively. The difference in stone clearance rates between the two groups was not statistically significant (p = 0.186). A total of 11 patients (12.6 %) in the Primary group and 18 patients (20.7 %) in the Salvage group underwent an adjuvant procedure (p = 0.154). No statistically significant differences were noted in terms of complications, procedure duration and length of hospitalization. In the Primary group, the laser energy used for stone fragmentation was higher (p = 0.043). The rate of ureteric stenting at the end of the procedure was higher for the Salvage group (p = 0.030). Previous failed ESWL is not a predictor for unfavorable outcome of URS. Salvage URS is associated, however, with an increased need for ureteric stenting at the end of the procedure.
authors: Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB, UK, brucemed@hotmail.com.
authors: Prodromos
authors: P
authors: Philippou
authors: David
authors: D
authors: Payne
authors: Kim
authors: K
authors: Davenport
authors: Anthony G
authors: AG
authors: Timoney
authors: Francis X
authors: FX
authors: Keeley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000706:statistics & numerical data*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016879:Salvage Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000706:statistics & numerical data*; D052878:Urolithiasis / Q000628:therapy*
references: Eur Urol. 2007 Jun;51(6):1688-93; discussion 1693-4
references: 17161522
references: J Urol. 2011 Jan;185(1):160-3
references: 21074810
references: J Urol. 2004 Jul;172(1):175-9
references: 15201765
references: J Endourol. 2006 Aug;20(8):556-9
references: 16903814
references: BJU Int. 1999 Aug;84(3):257-60
references: 10468717
references: J Urol. 2002 Jan;167(1):31-4
references: 11743269
references: J Urol. 2009 Mar;181(3):1158-62
references: 19152940
references: Eur Urol. 2007 Dec;52(6):1610-31
references: 18074433
references: Urology. 2008 Feb;71(2):214-7
references: 18308086
references: J Endourol. 2008 Mar;22(3):443-6
references: 18355139
references: J Endourol. 2003 May;17(4):201-5
references: 12816580
references: J Urol. 2005 Mar;173(3):848-57
references: 15711292
references: J Urol. 2006 Oct;176(4 Pt 1):1453-6; discussion 1456-7
references: 16952658
references: BJU Int. 2008 Sep;102(8):1010-7
references: 18485033
references: J Urol. 1999 Dec;162(6):1904-8
references: 10569534
references: J Urol. 1995 May;153(5):1384-9
references: 7714947
references: Urology. 2012 Jan;79(1):61-6
references: 21855968
references: J Endourol. 2011 Jan;25(1):45-9
references: 21050026
references: Curr Opin Urol. 2008 Mar;18(2):214-9
references: 18303547
references: Urology. 1995 Mar;45(3):363-71
references: 7879329
references: Curr Opin Urol. 2011 Mar;21(2):141-4
references: 21200323
references: Urology. 2008 Oct;72(4):770-4
references: 18632141
references: J Urol. 1989 Mar;141(3 Pt 2):782-9
references: 2645437
references: Urologe A. 1999 Mar;38(2):128-32
references: 10231932
references: J Urol. 2009 Feb;181(2):663-7
references: 19091339
references: J Endourol. 2008 Feb;22(2):257-60
references: 18294030
references: J Endourol. 2007 Feb;21(2):151-4
references: 17338611
references: J Endourol. 2006 Dec;20(12):1025-9
references: 17206896
references: Korean J Urol. 2010 Nov;51(11):777-82
references: 21165199
references: J Urol. 2003 Dec;170(6 Pt 1):2198-201
references: 14634378
references: Scand J Urol Nephrol. 2006;40(5):380-4
references: 17060084