Efficacy and Safety of Salvage Ureteroscopy after Previously Failed Shockwave Lithotripsy

13 Jul, 21

Introduction

Shockwave lithotripsy (SWL) and ureteroscopy (URS) are the current common modalities used for the management of urinary stone disease. SWL is non-invasive outpatient procedure with standard antibiotic prophylaxis and lower complication rate whereas URS is inpatient procedure requiring peri-operative antibiotic prophylaxis. URS is often done as a salvage therapy in case of SWL-resistant stones in clinical practice. However, there are conflicting studies on the role of URS after failed SWL. Some studies conclude that URS after previous unsuccessful SWL results in lower stone free rate (SFR) with higher complications. Conversely, some studies demonstrate no impact on SFR and complications with URS in patients with failed SWL.

Aim

The outcomes of URS as primary procedure have been compared to salvage URS after previous unsuccessful SWL.

Method

Study Design

Meta-analysis

Treatment Strategy

PubMed, EMBASE, Web of Science and Cochrane Library databases were extensively searched to identify the eligible studies before October 2020.
The studies recruiting patients with renal or ureteral stones, in which the safety and efficacy of URS was evaluated with or without SWL and parameters such as SFR, time taken for the surgery and complications were assessed were eligible for this meta-analysis.
RevMan 5.3 software was used to analyze the endpoints.

Endpoints

SFR
Duration of surgery
Postoperative modified Clavien grade I-IV complications

Results

The meta-analysis included a total of 7 studies with 2413 individuals – 1096 patients undergoing URS after failed SWL [SWL(+)] and 1317 patients treated primarily with URS [SWL(-)].
The SFR was comparable across both the groups [odds ratio (OR) =0.84, p=0.15]
There was no statistically significant difference in the duration of surgery among the groups [weighted mean difference (WMD) =6.79, p=0.19].
SWL (+) and SWL (-) groups did not have any significant differences with respect to modified Clavien grade I complications - fever (OR: 1.36; P=0.32) and hematuria (OR: 0.81; P=0.75),
There were no statistically significant differences in modified Clavien grade II-IV complications such as urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38).

Conclusion

The salvage ureteroscopy (URS) after previous unsuccessful shockwave lithotripsy (SWL) had similar stone free rates, duration of surgery and postoperative complications, demonstrating comparable efficacy and safety to primary URS.

Transl Androl Urol. 2021 May;10(5):2122-32. Doi: 10.21037/tau-21-39.