Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
Business School Manchester Metropolitan University, Manchester, M15 6BH, UK.
Urolithiasis. 2023 Jun 5;51(1):86. doi: 10.1007/s00240-023-01460-4.
The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%, P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%, P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%, P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%, P = 0.019). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB; P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.
对于远端输尿管结石的最佳治疗方式存在争议。因此，我们进行了一项前瞻性研究，以评估早期行第二次体外冲击波碎石术（SWL）与输尿管镜碎石术（URS）治疗远端输尿管结石患者的疗效、安全性和成本。这项前瞻性研究于 2020 年 6 月至 2022 年 4 月在一家三级医院进行。纳入接受 SWL 或 URS 治疗的远端输尿管结石患者。记录结石清除率（SFR）、二次治疗率、并发症和成本。还进行了倾向评分匹配（PSM）分析。共纳入 1023 例患者，其中 68.4%（700 例）接受 SWL 治疗，31.6%（323 例）接受 URS 治疗。根据 PSM，SWL 在 SWL 后 1 个月的 SFR（87.4%比 84.9%，P=0.325）和二次治疗率（10.7%比 10.8%，P=0.958）与 URS 相当。并发症少见，SWL 和 URS 组之间无差异（6.0%比 5.9%，P>0.05），但 URS 组输尿管损伤（即穿孔）的发生率高于 SWL 组（1.3%比 0%，P=0.019）。SWL 组的住院时间明显更短（1 天比 2 天，P<0.001），成本明显更低（2000 人民币比 25030 人民币；P<0.001）。这项前瞻性研究表明，对于远端输尿管结石患者，早期行第二次 SWL 治疗与 URS 相比，疗效相当，并发症发生率和成本更低。我们的研究结果可能有助于指导临床决策。
