Both Surgery and Shock Waves Effective in Removing Kidney Stones

A new study has found that two common methods for removing kidney stones, surgery and shock wave treatments, are effective and safe, and neither is clearly superior to the other.

Researchers from the University of Aberdeen (UK) performed a systematic review of six trials--involving 833 adults--that compared two minimally invasive kidney stone therapies: ureteroscopy (with or without intracorporeal lithotripsy) and extracorporeal shock wave lithotripsy (ESWL). The reviewed trials compared several different health outcomes: whether or not the patient was free of kidney stones, the need for additional treatment, therapy complications, and time of hospitalization.

Results gathered three or four months after treatment suggested that surgery outperformed ESWL to completely clear kidney stones. However, the success of the ESWL treatment varied depending on the kind of lithotripter used. Overall, the researchers concluded that people treated with ureteroscopy achieve a higher stone-free rate, but have a longer hospital stay and more complications, although most problems were minor. The review was published in the January 2007 issue of The Cochrane Library.

"The most important finding from our review is that current practice of managing urerteric stones is based on poor-quality evidence, mostly from small trials with a lot of heterogeneity,” said lead investigator Ghulam Nabi, M.S., M.Ch., a lecturer in the health services research unit of the University of Aberdeen.

ESWL uses highly focused impulses projected from outside the body to pulverize kidney stones; in ureteroscopy, an ureterscope is passed through the urethra and up into the ureter or kidney; after identifying stones. They are removed with a cage-like device called a basket, or broken up with lasers into multiple small pieces that can easily pass out the urinary tract.



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