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EAU 2019

EAU 2019: Shockwave Lithotripsy and Ureteroscopy for the Treatment of Lower Pole Stones: Results from a Statewide Clinical Registry

Barcelona, Spain (UroToday.com) There are different options for treatment of lower pole (LP) renal stones. A choice is based on patient anatomy, stone factors and surgeon’s preferences. However, only a few large comparative studies have been published. Dr. Ghani from the University of Michigan assessed the efficacy and morbidity of shockwave lithotripsy (SWL) and ureteroscopy (URS) for treating LP stones of a different size.

For this purpose, authors used data from Michigan Urological Surgery Improvement Collaborative Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) quality initiative. This prospective registry includes data from 24 participating practices on patients undergoing URS and SWL. All patients with LP stones that underwent SWL or URS from June 2016 to July 2018 were analyzed. The demographic factors, emergency department (ED) visit and hospitalization rates, as well as stone-free rates (SFR) after 60 days, were compared. In addition, authors carried out a sub-group analysis with stratification by stone size <1 cm and 1-2 cm.

A total of 832 (63.3%) SWL and 483 (36.7%) URS procedures were analyzed. In both groups, there was no difference in the mean stone size (mm) [SWL 8.0 vs URS 8.3, p=0.27]. A majority of procedures was performed for stones <1 cm (74.4%), followed by 1-2 cm (24.5%) and >2 cm stones (1.1%). In URS group, patients had significantly greater rates of medical comorbidity, female gender, positive urine culture, pre-operative hydronephrosis and antiplatelet therapy (p<0.05). Stenting before and after the procedure was more common in URS group. Although an overall 30-day ED visit rate was higher for URS (12.6 vs. 2.5%, p<0.001), there was no difference for stones 1-2 cm. Overall stone clearance was higher after URS (56.5% vs. 39.4%, p<0.0001), as well as values for < 1 cm stones (64.1% vs. 44.3%, p<0.0001) and 1-2 cm stones (38.0% vs.25.0%, p<0.05) (table 2). For stones 1-2 cm, there were no significant differences in complications between URS and SWL.

EAU2019 shockwave lithotripsy and ureteroscopy


Dr. Ghani concluded that URS provides better efficacy than SWL for treating LP stones, but this method is associated with increased morbidity. However, for stones 1-2 cm in size, URS demonstrates superior stone clearance with no significant difference in complications. Although SWL is still commonly used for LP stones, the results of this study can allow developing the treatment appropriateness criteria for SWL.


Presented by: Khurshid Ridwan Ghani, MB, BCh, University of Michigan, Department of Urology, Ann Arbor, Michigan, United States.

Written by: Kirill Shiranov, MD, Fellow, Department of Urology, Rostov University, Rostov on Don, Russia, Twitter: @endourologist and Zhamshid Okhunov, MD, Twitter: @OkhunovZham, Department of Urology, the University of California-Irvine at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.