Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.
BACKGROUND
There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones.


OBJECTIVE
To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones.


METHODS
Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared.


RESULTS
Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive.


CONCLUSIONS
ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Yon
Y
Cui
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Wenzhou
W
Cao
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Hua
H
Shen
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Jianjun
J
Xie
Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America.
Tamara S
TS
Adams
Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America.
Yuanyuan
Y
Zhang
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Qiang
Q
Shao
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008096:Lithotripsy / Q000379:methods*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*