Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones

  • Ibrahim Kartal | ibrahimguvenkartal@gmail.com Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara, Turkey.
  • Burhan Baylan Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara, Turkey.
  • Mehmet Çağlar Çakıcı Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara; Department of Urology Goztepe Training and Research Hospital, Faculty of Medicine, Medeniyet University, Istanbul, Turkey.
  • Sercan Sarı Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara; Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey.
  • Volkan Selmi Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara; Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey.
  • Harun Ozdemir Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara; Department of Urology, Ministry of Health Haseki Education Research Hospital, Health Sciences University, Istanbul, Turkey.
  • Fatih Yalçınkaya Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara, Turkey.

Abstract

Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter.
Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes.
Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients’ demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones.
Conclusions: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.

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Published
2020-04-06
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Section
Original Papers - Stones and Infections
Keywords:
Lithotripsy, Ureter, Ureteroscopy
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How to Cite
Kartal, I., Baylan, B., Çakıcı, M., Sarı, S., Selmi, V., Ozdemir, H., & Yalçınkaya, F. (2020). Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones. Archivio Italiano Di Urologia E Andrologia, 92(1), 39-44. https://doi.org/10.4081/aiua.2020.1.39