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Decreased Recurrence of Urolithiasis After Simultaneous Ureteroscopic Surgery for Ureter and Ipsilateral Renal Calculi: Comparison to Shockwave Lithotripsy for Ureter Calculi Alone

Published:November 09, 2020DOI:https://doi.org/10.1016/j.urology.2020.10.041

      ABSTRACT

      Objective

      To compare follow-up outcomes of ureteroscopy (URS) and shockwave lithotripsy (SWL) for ureter calculi in the setting of asymptomatic renal calculi <15 mm.

      Methods

      This study included 789 patients who underwent URS (n = 301) or SWL (n = 488) as primary treatment for ureter calculi and who had ipsilateral renal calculi <15 mm between January 2012 and December 2019. For the URS group, all renal calculi were simultaneously treated unless contraindicated. One-to-one matching was performed using the propensity score (PS).

      Results

      After PS matching, analysis included 262 matched pairs of URS and SWL patients. The stone-free rate for ureter calculi without auxiliary procedure was 97.3% in the URS group and 93.9% in the SWL group. Any complication rates were 11.0% and 9.2% in the URS and SWL group, respectively; 1.1% of the URS patients experienced complications classified as Clavien–Dindo ≥IIIb. The estimated 2-year intervention-free survival was 88.1% in the URS group and 84.2% in the SWL group (P = 0.045). The estimated 2-year stone-event-free survival was 80.1% in the URS group and 71.0% in the SWL group (P = 0.009). Cox multivariate analysis showed that the hazard ratios of URS were 0.62 (P = 0.025) for surgical interventions and 0.64 (P = 0.008) for stone-related events after adjusting for baseline variables.

      Conclusion

      For patients with symptomatic ureter calculi and asymptomatic renal calculi <15 mm, URS with active treatment for renal calculi reduces future ipsilateral surgical intervention and stone-related events compared with SWL for ureter calculi.
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      References

        • Sorokin I
        • Mamoulakis C
        • Miyazawa K
        • Rodgers A
        • Talati J
        • Lotan Y
        Epidemiology of stone disease across the world.
        World J Urol. 2017; 35: 1301-1320
        • Abe T
        • Akakura K
        • Kawaguchi M
        • et al.
        Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution.
        J Endourol. 2005; 19: 768-773
        • Lim SH
        • Jeong BC
        • Seo SI
        • Jeon SS
        • Han DH
        Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free.
        Korean J Urol. 2010; 51: 777-782
        • Han DS
        • Cher BAY
        • Lee D
        • Rajendran S
        • Riblet NBV
        • Pais Jr., VM
        The durability of active surveillance in patients with asymptomatic kidney stones: a systematic review.
        J Endourol. 2019; 33: 598-605
        • Kang HW
        • Lee SK
        • Kim WT
        • et al.
        Natural history of asymptomatic renal stones and prediction of stone related events.
        J Urol. 2013; 189: 1740-1746
        • Türk C
        • Neisius A
        • Petrik A
        • Seitz C
        • Skolarikos A
        • Thomas K
        EAU Guidelines on Urolithiasis.
        EAU Guidelines Office, EAU Guidelines Office, Arnhem, The Netherlands2020
        • Assimos D
        • Krambeck A
        • Miller NL
        • et al.
        Surgical management of stones: American Urological Association/Endourological Society Guideline, PART I.
        J Urol. 2016; 196: 1153-1160
        • Cocuzza M
        • Colombo Jr, JR
        • Ganpule A
        • et al.
        Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.
        J Endourol. 2009; 23: 253-257
        • Lai D
        • Chen M
        • He Y
        • Li X
        Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal.
        BMC Urol. 2015; 15: 22
        • Bilgasem S
        • Pace KT
        • Dyer S
        • Honey RJ
        Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for ureteral stones.
        J Endourol. 2003; 17: 397-400
        • Alkan E
        • Turan M
        • Ozkanli O
        • et al.
        Combined ureterorenoscopy for ureteral and renal calculi is not associated with adverse outcomes.
        Cent European J Urol. 2015; 68: 187-192
        • Kanda Y.
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transpl. 2013; 48: 452-458
        • Dropkin BM
        • Moses RA
        • Sharma D
        • Pais Jr., VM
        The natural history of nonobstructing asymptomatic renal stones managed with active surveillance.
        J Urol. 2015; 193: 1265-1269
        • Darrad MP
        • Yallappa S
        • Metcalfe J
        • Subramonian K
        The natural history of asymptomatic calyceal stones.
        BJU Int. 2018; 122: 263-269
        • Vaughan LE
        • Enders FT
        • Lieske JC
        • et al.
        Predictors of symptomatic kidney stone recurrence after the first and subsequent episodes.
        Mayo Clin Proc. 2019; 94: 202-210
        • Seseke S
        • Rudolph R
        • Rebmann U
        Asymptomatic renal stones: do they really exist?.
        Aktuelle Urol. 2011; 42: 374-377
        • Keeley Jr., FX
        • Tilling K
        • Elves A
        • et al.
        Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones.
        BJU Int. 2001; 87: 1-8
        • Portis AJ
        • Laliberte MA
        • Heinisch A
        Repeat surgery after ureteroscopic laser lithotripsy with attempted complete extraction of fragments: long-term follow-up.
        Urology. 2015; 85: 1272-1278
        • Iremashvili V
        • Li S
        • Penniston KL
        • Best SL
        • Hedican SP
        • Nakada SY
        Role of residual fragments on the risk of repeat surgery after flexible ureteroscopy and laser lithotripsy: single center study.
        J Urol. 2019; 201: 358-363
        • Ozgor F
        • Sahan M
        • Yanaral F
        • Savun M
        • Sarilar O
        Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results.
        Int Braz J Urol. 2018; 44: 314-322
        • Lee YH
        • Tsai JY
        • Jiaan BP
        • Wu T
        • Yu CC
        Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones.
        Urology. 2006; 67 (discussion 4): 480-484
        • Traxer O
        • Thomas A
        Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery.
        J Urol. 2013; 189: 580-584
        • Yoshimura E
        • Sawada SS
        • Lee IM
        • et al.
        Body mass index and kidney stones: a cohort study of Japanese men.
        J Epidemiol. 2016; 26: 131-136
        • Sarica K
        Obesity and stones.
        Curr Opin Urol. 2019; 29: 27-32
        • Krambeck A
        • Wijnstok N
        • Olbert P
        • et al.
        The influence of body mass index on outcomes in ureteroscopy: results from the clinical research office of Endourological Society URS Global Study.
        J Endourol. 2017; 31: 20-26
        • Ghani KR
        • Wolf Jr., JS
        What is the stone-free rate following flexible ureteroscopy for kidney stones.
        Nat Rev Urol. 2015; 12: 281-288
        • Rule AD
        • Lieske JC
        • Li X
        • Melton 3rd, LJ
        • Krambeck AE
        • Bergstralh EJ
        The ROKS nomogram for predicting a second symptomatic stone episode.
        J Am Soc Nephrol. 2014; 25: 2878-2886
        • Kanno T
        • Takahashi T
        • Ito K
        • Okada T
        • Higashi Y
        • Yamada H
        The natural history of asymptomatic renal stones ≤5 mm: comparison with ≥5 ;mm.
        J Endourol. 2020; https://doi.org/10.1089/end.2020.0336
        • Kanno T
        • Kubota M
        • Funada S
        • Okada T
        • Higashi Y
        • Yamada H
        The utility of the kidneys-ureters-bladder radiograph as the sole imaging modality and its combination with ultrasonography for the detection of renal stones.
        Urology. 2017; 104: 40-44
        • Kanno T
        • Kubota M
        • Sakamoto H
        • et al.
        The efficacy of ultrasonography for the detection of renal stone.
        Urology. 2014; 84: 285-288