Comparison of ureteroscopy (URS) complementary treatment after extracorporeal shock wave lithotripsy failure with primary URS lithotripsy with holmium laser treatment for proximal ureteral stones larger than10mm

Abstract Background To compare ureteroscopy (URS) complementary treatment following extracorporeal shock wave lithotripsy (SWL) failure with primary URS lithotripsy for proximal ureteral stones > 10 mm, and try to find out acceptable number of SWL sessions followed by safe URS. Methods This was a retrospective study following approval from Medical Ethics Committee of People's Hospital of Chongqing Banan District. Patients (n = 340) who received URS in our hospital for stones > 10 mm from Jan 2015 to June 2020 were divided into two groups according to their previous SWL history. Group 1 consisted of 160 patients that underwent unsuccessful SWL before URS. Group 2 encompassed 180 patients without SWL before URS. Patient’s operative outcomes were compared. A logistic regression and receiver operator characteristics (ROC) were used to identify the acceptable number of SWL sessions prior to URS, regarding the intra-operative complications of URS. Results The group 1 required more surgery time (41.38 ± 11.39 min vs. 36.43 ± 13.36 min, p = 0.01). At the same time, more intra-operative (68.1% VS 22.8%, p < 0.05) and post-operative (35% VS 18.0%, p = 0.001) complications occurred in group 1. Need more hospital stay in group 1 (2.7 ± 1.2 days vs 1.6 ± 1.1 days, p < 0.05). More patients in group 1 need further URS (16.3% VS 8.9%, p = 0.029). After second URS, the SFR of URS in two groups was insignificant differences (82.5% VS 88.9%, p > 0.05). The median (25–75%) of SWL sessions before URS was 2 (1–3) in group 1. According to the results of logistic regression analysis, patients suffered more SWL failure have an increased risk of complications during URS (OR = 1.995, 95% CI: 1.636–2.434). ROC showed that the optimal number of SWL session followed by URS were 0.5, with a sensitivity of 67.7% and specificity of 71.5%. Intra-operative complication rates of URS treatment were higher in patients who suffered > 1 SWL failure (72.6% vs 57.4%, p = 0.047). Conclusion There was no acceptable number of SWL sessions that could be followed by URS with fewer intra-operative complications. Patients who underwent previous SWL were likely to suffer more intra-operative complications, the average operating time, hospitalization time, and needing further treatment, during URS treatment for proximal ureteral stones larger than 10 mm.

Download Full-text

Comparison of Ureteroscopy (URS) Complementary Treatment after Extracorporeal Shock Wave Lithotripsy Failure with Primary URS Lithotripsy with Holmium Laser Treatment for Proximal Ureteral Stones Larger than 10mm

10.21203/rs.3.rs-556588/v1 ◽

2021 ◽

Author(s):

Feng Yao ◽

XiaoLiang Jiang ◽

Bin Xie ◽

Ning Liu

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Operating Time ◽

Ureteral Stones ◽

Complication Rates ◽

Complementary Treatment ◽

Extracorporeal Shock Wave ◽

Operative Complications ◽

Group 1

Abstract Background: To compare ureteroscopy (URS) complementary treatment following extracorporeal shock wave lithotripsy (SWL) failure with primary URS lithotripsy for proximal ureteral stones ＞ 10 mm, and try to find out optimal SWL session followed by safe URS.Methods: This was a retrospective study following approval from Medical Ethics Committee of People's Hospital of Chongqing Banan District. Patients (n=340) who received URS in our hospital for stones ＞10 mm from Jan 2015 to June 2020 were divided into two groups according to their previous SWL history. Group 1 consisted of 160 patients that underwent unsuccessful SWL before URS. Group 2 encompassed 180 patients without SWL before URS. Patient’s operative outcomes were compared. Receiver operator characteristics were used to identify the optimal SWL session, regarding the intra-operative complications of URS.Results: The group 1 required more surgery time (41.38 ± 11.39 min vs. 36.43 ± 13.36 min, P=0.01). At the same time, more intra-operative (68.1% VS 22.8%, p = 0.000) and post-operative (35% VS 18.0%, p = 0.001) complications occurred in group 1. Need more hospital stay in group 1 (2.7 ± 1.2 days vs 1.6 ± 1.1 days, p < 0.05). More patients in group 1 need further URS (16.3% VS 6.7%, p = 0.004). After second URS, the SFR of URS was insignificant differences (82.5% VS 88.9%, p＞ 0.05). The median (25% - 75%) of SWL sessions before URS was 2(1-3) in group 1. The optimal SWL session followed by URS were 0.5 (Area Under Curve = 0.718, p ＜ 0.001) with a sensitivity of 67.7% and specificity of 71.5%. Intra-operative complication rates of URS treatment were higher in patients who suffered ＞ 1 SWL failure (72.6% vs 57.4%, p = 0.047).Conclusion: There was no optimal SWL session that could be followed by URS with fewer intra-operative complications. Patients who underwent previous SWL were likely to suffer more intra-operative complications, the average operating time, hospitalization time, and needing further treatment, during URS treatment for proximal ureteral stones larger than 10 mm.

Download Full-text

Usefulness of adjunctive alpha1-adrenergic antagonists, after single extracorporeal shock wave lithotripsy session, in ureteral stone expulsion.

Canadian Urological Association Journal ◽

10.5489/cuaj.1261 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 8 ◽

Cited By ~ 8

Author(s):

Abdellatif Janane ◽

Abdelaziz Hamdoun ◽

Fouad Hajji ◽

Youssef Dakkak ◽

Mohamed Ghadouane ◽

...

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Ureteral Stones ◽

Extracorporeal Shock Wave ◽

Standard Medical Therapy ◽

Ureteral Colic ◽

Adrenergic Antagonists ◽

Group 2 ◽

Group 1

Introduction: We evaluate the efficiency of alpha-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.Methods: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL.Results: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%).Conclusion: Adjunctive therapy with alpha1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of alpha-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.

Download Full-text