Ureteroscopy achieves higher stone-free rates but results in slightly more complications.

Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are both safe and effective for removing ureteral stones, and neither is clearly superior to the other, according to a meta-analysis of randomized controlled studies.

The analysis showed that ureteroscopic removal of ureteral stones achieves a higher stone-free rate but results in more minor complications and longer hospital stays, researchers reported in the March issue of Cochrane Database of Systematic Reviews. The Reviews are published by the Cochrane Collaboration, an international organization that evaluates medical research.

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“Patients with ureteric stones should be informed about the outcomes of various interventions, and our review will form the basis of such a discussion,” said lead investigator Ghulam Nabi, MD, a clinical lecturer in the Academic Urology Unit and Health Services Research Unit of the University of Aberdeen in Scotland. “This is the first attempt to synthesize literature using strict inclusion and exclusion criteria of Cochrane review methodology.”

His group noted that their most important finding “is that current practice of managing ureteric stones is based on poor-quality evidence, from small trials with a lot of heterogeneity.”

It is well known that ESWL treatment is less invasive, but it has limitations, such as a high retreatment rate. Advances in ureteroscopy over the past 10 years have significantly increased the success rates and reduced complications associated with this procedure, they noted.

The reviewers analyzed data from five trials involving 732 adults. Results gathered three or four months after treatment suggest that surgery outperformed ESWL to completely clear kidney stones, but that ESWL outcomes depended on the kind of lithotripter machine used.

Commenting on the meta-analysis, Glenn M. Preminger, MD, director of the Comprehensive Kidney Stone Center at Duke University Medical Center in Durham, N.C., observed: “At this point it is important to say that both methods work and both have their advantages for different patients. The choice of intervention really depends on the size and location of the stone.”