Ureteroscopy vs Shockwave Lithotripsy for Lower Pole Renal Stones: Treatment Variation and Outcomes in a Surgical Collaborative.

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 (

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.

Volume

Online ahead of print

First Page

101097

Last Page

101097

DOI

10.1097/JU.0000000000004628

ISSN

1527-3792

PubMed ID

40489579

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