Ureteroscopy vs Shockwave Lithotripsy for Lower Pole Renal Stones: Treatment Variation and Outcomes in a Surgical Collaborative
Recommended Citation
DiBianco JM, Daignault-Newton S, Moncaleano GF, Stockall E, Hiller S, Kim HJ, Pimentel H, Wenzler D, Seifman B, Kachroo N, Dauw CA, and Ghani KR. Ureteroscopy vs Shockwave Lithotripsy for Lower Pole Renal Stones: Treatment Variation and Outcomes in a Surgical Collaborative. J Urol 2025;101097.
Document Type
Article
Publication Date
6-9-2025
Publication Title
The Journal of urology
Abstract
PURPOSE: AUA guidelines recommend ureteroscopy (URS) or shockwave lithotripsy (SWL) for lower pole (LP) stones ≤ 1 cm, while SWL is second line for stones > 1 to 2 cm. In the era of increasing URS, there are limited data on the modality used and outcomes. We assessed treatment distribution, stone-free rates (SFR), and unplanned health care.
MATERIALS AND METHODS: Using the Michigan Urological Surgery Improvement Collaborative registry, we identified URS and SWL cases for LP stones ≤ 2 cm (2016-2021). We assessed the frequency of patients receiving URS or SWL as a proportion of their LP treatment. A logistic model determined predictive probability of treatment modality. Differences in complete SFRs, postoperative emergency department visits, and hospitalizations were assessed by size (≤1 cm, >1-2 cm), adjusted for patient factors and correlation within practice/provider.
RESULTS: There were 3645 procedures from 35 practices (209 surgeons); 2287 (62.7%) had SWL. 80.2% of stones were ≤ 1 cm. There was variation in modality based on practice (P < .001) and surgeon (P < .001). For stones ≤ 1 cm, the SFR was higher for URS (56% vs 39%; P < .001). There were no significant differences in SFRs for > 1 to 2 cm stones. Emergency department visits were higher after URS for stones ≤ 1 cm (OR: 2.95, 95% CI: 1.7-5.0) but not for > 1 to 2 cm stones (OR: 0.97, 95% CI: 0.4-2.2). URS for stones ≤ 1 cm was associated with increased hospitalizations (OR: 4.67, 95% CI: 1.7-12.9) but not for stones > 1 to 2 cm (OR: 0.96, 95% CI: 0.4-2.2).
CONCLUSIONS: In Michigan, SWL is the chosen modality for LP stones ≤ 2 cm. For smaller stones, URS was more effective but had greater morbidity. For larger stones, both modalities demonstrated suboptimal efficacy. Our work demonstrates the need for interventions to improve outcomes.
Medical Subject Headings
Humans; Lithotripsy/statistics & numerical data/methods/adverse effects; Kidney Calculi/therapy/pathology/surgery; Ureteroscopy/statistics & numerical data; Male; Female; Middle Aged; Treatment Outcome; Michigan; Aged; Registries/statistics & numerical data; Adult; Retrospective Studies; Hospitalization/statistics & numerical data; nephrolithiasis; quality improvement; retrograde intrarenal surgery; shock wave lithotripsy; ureteroscopy; urolithiasis
PubMed ID
40489579
ePublication
ePub ahead of print
First Page
101097
Last Page
101097
