Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi

M. S. Pearle, R. Nadler, E. Bercowsky, C. Chen, M. Dunn, R. S. Figenshau, D. M. Hoenig, E. M. McDougall, J. Mutz, S. Y. Nakada, A. L. Shalhav, Chandru Sundaram, Jr Wolf J.S., R. V. Clayman

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Purpose: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. Materials and Methods: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94% of patients who underwent shock wave lithotripsy versus 75% who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91% of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9% and 25% of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94% for shock wave lithotripsy and 87% for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. Conclusions: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.

Original languageEnglish (US)
Pages (from-to)1255-1260
Number of pages6
JournalJournal of Urology
Volume166
Issue number4
StatePublished - 2001
Externally publishedYes

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Ureteral Calculi
Ureteroscopy
Lithotripsy
Patient Satisfaction
Flank Pain
Dysuria
Outpatients
Therapeutics
Radio Waves
Costs and Cost Analysis
Hydronephrosis
Operating Rooms
Postoperative Pain

Keywords

  • Laser
  • Lithotripsy
  • Ureteral calculi
  • Ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

Pearle, M. S., Nadler, R., Bercowsky, E., Chen, C., Dunn, M., Figenshau, R. S., ... Clayman, R. V. (2001). Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. Journal of Urology, 166(4), 1255-1260.

Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. / Pearle, M. S.; Nadler, R.; Bercowsky, E.; Chen, C.; Dunn, M.; Figenshau, R. S.; Hoenig, D. M.; McDougall, E. M.; Mutz, J.; Nakada, S. Y.; Shalhav, A. L.; Sundaram, Chandru; Wolf J.S., Jr; Clayman, R. V.

In: Journal of Urology, Vol. 166, No. 4, 2001, p. 1255-1260.

Research output: Contribution to journalArticle

Pearle, MS, Nadler, R, Bercowsky, E, Chen, C, Dunn, M, Figenshau, RS, Hoenig, DM, McDougall, EM, Mutz, J, Nakada, SY, Shalhav, AL, Sundaram, C, Wolf J.S., J & Clayman, RV 2001, 'Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi', Journal of Urology, vol. 166, no. 4, pp. 1255-1260.
Pearle MS, Nadler R, Bercowsky E, Chen C, Dunn M, Figenshau RS et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. Journal of Urology. 2001;166(4):1255-1260.
Pearle, M. S. ; Nadler, R. ; Bercowsky, E. ; Chen, C. ; Dunn, M. ; Figenshau, R. S. ; Hoenig, D. M. ; McDougall, E. M. ; Mutz, J. ; Nakada, S. Y. ; Shalhav, A. L. ; Sundaram, Chandru ; Wolf J.S., Jr ; Clayman, R. V. / Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. In: Journal of Urology. 2001 ; Vol. 166, No. 4. pp. 1255-1260.
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abstract = "Purpose: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. Materials and Methods: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94{\%} of patients who underwent shock wave lithotripsy versus 75{\%} who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91{\%} of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9{\%} and 25{\%} of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94{\%} for shock wave lithotripsy and 87{\%} for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. Conclusions: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.",
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T1 - Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi

AU - Pearle, M. S.

AU - Nadler, R.

AU - Bercowsky, E.

AU - Chen, C.

AU - Dunn, M.

AU - Figenshau, R. S.

AU - Hoenig, D. M.

AU - McDougall, E. M.

AU - Mutz, J.

AU - Nakada, S. Y.

AU - Shalhav, A. L.

AU - Sundaram, Chandru

AU - Wolf J.S., Jr

AU - Clayman, R. V.

PY - 2001

Y1 - 2001

N2 - Purpose: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. Materials and Methods: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94% of patients who underwent shock wave lithotripsy versus 75% who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91% of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9% and 25% of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94% for shock wave lithotripsy and 87% for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. Conclusions: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.

AB - Purpose: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. Materials and Methods: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94% of patients who underwent shock wave lithotripsy versus 75% who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91% of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9% and 25% of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94% for shock wave lithotripsy and 87% for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. Conclusions: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.

KW - Laser

KW - Lithotripsy

KW - Ureteral calculi

KW - Ureteroscopy

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