Category: Clinical Stones: SWL

MP9-19 - Efficacy and Patient Satisfaction Of Flexible Ureteroscopy, Semirigid Ureteroscopy And Extracorporeal Shockwaves Lithotripsy In The Management Of Proximal Ureteric Stones: A Randomized Trial

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Objective:   to compare the outcome of flexible ureteroscopy (F-URS), semirigid ureteroscopy (SR-URS) and extracorporeal shockwaves lithotripsy (SWL) for treatment of proximal ureteral stones 0.5 to 1 cm and treatment related patient satisfaction.


Methods :


Methods:
   The study was performed in Mansoura Urology and Nephrology Center (UNC).ClinicalTrials.gov (ID: NCT02469766)


Patients who presented with radio-opaque proximal ureteral calculi 0.5 to 1 cm in size with no distal ureteric obstruction nor moderate to marked back pressure were included in the study in the period between March 2015 and April 2016 the randomization process was performed using computer-generated tables in ratio 1:1:1. A sample size of 240 patients (80 in each group) was estimated to reach 80% power of the study. Patients were randomly assigned to one of the 3 study groups; group 1 (SWL), group 2 (SR-URS) and group 3 (F-URS). SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Gemini). SR-URS was performed using an 8F semirigid ureteroscope. The 7.5 F flexible ureteroscope was used with holmium laser energy. Results were compared between treatment groups using the chi-square test for categorical variables and one way ANOVA test for quantitative variable. The primary end point was success rates while the secondary end points were retreatment rates,complications and patient satisfaction. Patient satisfaction was measured with the Freiburg Index of Patient Satisfaction (FIPS) questionnaire.


Results :

Out of 249 patients, one patient in SWL group didn’t receive allocated treatment because the stone could not be localized and 8 patients missed follow up.  Therefore, 240 patients were included in the final analysis. The success rate was 92.5% for F-URS vs 89.5% for SR-URS and 81.5% for SWL (P .081). The retreatment rate was significantly greater in the SWL group than in the SR-URS group and F-URS (54% vs. 3.8%and 0%, respectively; P.001). The complication rate was 6.3% in the SR-URS group (with reported avulsion in one case), 6.2% in the F-URS group and 4.9% in the SWL group (P. 0.69). Patients’ satisfaction was high in all techniques with significant difference in favor of SWL (P. 0.000). Mean FIPS score in F-URS was 2.60 while SR-URS 2.88 and SWL 2.37.


Conclusions :

For treatment of proximal ureteric stone of 0.5-1 cm, F-URS seems to be a better choice due to higher SFR and lower retreatment rate in comparison with SWL and it was safer than S-URS. SWL showed longer operative time and higher retreatment rate; nevertheless it showed higher patient satisfaction on view of rapid recovery and less invasive nature.

Muhamad Abdullateef

Fellow
Mansoura urology Center
Mansoura, Ad Daqahliyah, Egypt

Urologist at Mansoura urology and Nephrology Center
Mansoura university
Egypt

Ahmed M. Shoma

Mansoura, Ad Daqahliyah, Egypt

Ahmed R. EL-Nahas

Consultant in Urology
Amiri Hospital
Mansoura, Ad Daqahliyah, Egypt

Ahmed M. Elshal

Lecturer
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

Ahmed M. Mansour

Mansoura, Ad Daqahliyah, Egypt

Abdelwahab Hashem

Clinical fellow
Urology and Nephrology Center, Mansoura University, Egypt.
Mansoura, Ad Daqahliyah, Egypt

EL-Housseiny I Ibrahiem

Mansoura, Ad Daqahliyah, Egypt

Khaled Z. Sheir

Mansoura, Ad Daqahliyah, Egypt