Re-treatment for kidney and ureteral stones is more likely with shock wave lithotripsy (SWL) than ureteroscopy (URS), investigators reported in the Journal of Urology (2020;203:1156-1162).

Diana K. Bowen, MD, of The Children’s Hospital of Pennsylvania in Philadelphia, and collaborators studied a retrospective cohort using all-payer claims data for patients who underwent SWL or URS from 1997 to 2016 at 74 hospitals in South Carolina. The primary outcome measure was subsequent SWL or URS within 6 months of initial surgery.

Overall, 136,152 SWL and URS procedures were performed in 95,227 unique patients, with re-treatment representing 9% of all surgeries, according to the researchers. SWL was significantly associated with 20% increased odds of re-treatment compared with URS. Patients with initial SWL were more likely to have SWL for re-treatment (84.6%) than patients with initial URS were to have retreatment with URS (29.3%), the investigators reported.

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The odds of re-treatment were 7.5% for URS and 10.4% for SWL. Compared with patients who underwent URS, those who underwent SWL had significant 85% and 76% increased odds of re-treatment at 2 and 3 months, respectively, after the initial procedure.

“These results have implications for shared decision making and value-based surgical treatment of nephrolithiasis,” the authors concluded.


Bowen DK, Song L, Faerber J, et al. Re-treatment after ureteroscopy and shock wave lithotripsy: A population based comparative effectiveness study. J Urol. 2020;203:1156-1162. doi: 10.1097/JU.0000000000000712