NEW YORK (Reuters Health) - For most patients with large upper third ureteral stones, shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) yield comparable results, according to a report in the March issue of Urology.

"Our study showed that SWL and URSL were comparable for most patients with large upper third ureteral stones," Dr. Ying-Huei Lee from Chi Mei Medical Center, Tainan, Taiwan told Reuters Health. "After detailed illustrations of the advantages and disadvantages of these two different treatments, the decision making model should be patient-centered, not physician-centered."

Dr. Lee and colleagues compared the efficiency and cost-effectiveness of SWL and URSL for the treatment of large upper third ureteral stones in 35 men and 7 women.

Mean treatment time, visual analog scale pain scores, and hospital stay were significantly lower for SWL than for URSL, the authors report, but there were no differences in patient-reported satisfaction at the end of the study.

The efficiency quotients were similar for SWL (0.61) and URSL (0.63), the report indicates, as were the cost effectiveness indices ($1637 for SWL and $2154 for URSL).

All patients in the SWL group that had severe hydronephrosis required auxiliary surgical procedures to become stone free, the researchers note, and 2 patients in the URSL group required open ureterolithotomy because of ureteral perforation in one and an inaccessible stone in the other.

"We found that the efficiency quotients for SWL and URSL were comparable," the investigators write. "However, URSL is relatively invasive, requires longer hospitalization, and patients experienced more postoperative pain."

"Most of our patients more likely choose SWL as first-line treatment for upper third ureteral stones unless they had unsuccessful experiences during prior SWL treatment," Dr. Lee said.

"We strongly suggest that understanding the cost-effectiveness, success rate, pain score, and patient satisfaction score between the two different approaches constitutes an indispensable requisite for choosing the optimal first-line therapeutic strategy for patients with large upper third ureteral stones," the authors conclude.

Urology 2006;67:480-484

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