📃 Paper Title: Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less ('Lower Pole II')
🧍 Author: Pearle
🕒 Year: 2005
📚 Journal: Journal of Urology
🌎 Country: USA
ㅤContext to the study:
What are your options for treating a lower pole renal calculus? How does SWL compare with URS in this scenario?
ㅤ✅ Take-home message of study:
The 'Lower Pole II' study did not find strong evidence to favour either shockwave lithotripsy (SWL) or ureteroscopy (URS) for the management of lower pole caliceal stones measuring ≤10mm at three months of follow-up. SWL was, however, noted to have the benefits of better patient satisfaction, lesser analgesic requirement, and shorter time to recovery.
ㅤ A prospective, randomised trial
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Study participants:
Seventy-eight patients with isolated lower pole stones measuring 1 cm or less were randomised to SWL or URS. Sixty-seven patients completed treatment with SWL (32) and URS (35).
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Key study outcomes:
Primary outcome (stone-free rates at three months on non-contrast CT): not statistically different (SWL 35% versus URS 50%, p=0.92). Intraoperative complications higher with URS (n=7) than SWL (n=1). The rate of post-treatment complications was comparable (SWL 23% versus URS 21%, p=0.84). The postoperative analgesic requirement was significantly less in SWL patients as compared to URS patients (5.6 pills vs. 14.7 pills, p=0.02). Procedure time was significantly shorter for SWL (66 minutes versus 90 minutes, p=0.01). Patients were more likely to choose a repeat SWL as compared to repeat URS (90% SWL vs. 63% URS, p=0.03).
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Study Limitations:
The study was underpowered to validate a trend toward superior stone-free rates with URS. Advances in endoscopic technology in terms of access, stone fragmentation, and manoeuvrability likely mean that the results of this study no longer represent a valid comparison.
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