Shockwaves Work Better Than Surgery for Removing Small Stones in the Ureter

A new study states that extracorporeal shockwave lithotripsy (ESWL) should be the treatment of first choice in patients with a ureteric stone of up to one centimeter.

Researchers at the University Federico II (Naples, Italy) conducted a prospective randomized study involving 273 patients with single distal ureteric stones ranging from 0.5 cm - 1.5 cm, and compared the use of ESWL (137 patients) using an electromagnetic lithotripter to uretoscopy (URS, 136 patients), where an ureteroscope is passed into the distal ureter to remove the stone. Patients in both groups were compared for overall stone-free rates (SFRs), re-treatment rates, need for auxiliary procedures, and complication rates. A subgroup analysis was performed in both groups according to stone size.

The results showed that the patients in the ESWL group achieved a 92.7% overall SFR, with a 44.88% re-treatment rate and an 11.02% auxiliary procedure rate; complications occurred in 15.32% of patients treated with ESWL. Patients in the URS group achieved a 94.85% overall SFR, with a re-treatment rate of 7.75% and an auxiliary procedure rate of 18.60%; complications occurred in 19.11% of patients treated with URS. The need for re-treatments and for auxiliary procedures, as well as the incidence of complications was significantly higher in patients with stones larger than one centimeter in the ESWL group. In patients with stones smaller than one centimeter treated with ESWL, the need for re-treatments and auxiliary procedures, as well as the incidence of complications, was significantly lower than for those treated with URS. The study was published in the December 2010 issue of the British Journal of Urology International (BJUI).

"Statistical analysis showed no significant differences in overall stone free rates, treatment duration, complications, and the need for auxiliary procedures,” said coauthor Professor Vincenzo Mirone, M.D., of the department of urology. "However, there were clear differences in both groups when we divided them into patients with stones of up to one centimeter and stones of over one centimeter.”

"Approximately one in three adults with kidney stones will have a distal ureteric stone at some point in their lives. Most stones with a diameter of up to 0.5 centimeter will be expelled spontaneously when the patient urinates without requiring any active intervention. For larger stones that get stuck in the ureter, spontaneous expulsion is very difficult and requires active intervention,” added Professor Mirone.

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