Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi

Background: Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Extracorporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the two most commonly offered interventional procedures in these patients. ESWL treatment is less invasive but has some limitations such as a high retreatment rate and lack of availability in many centres. Advances in ureteroscopy over the past decade have increased the success rate and reduced complication rates. Objectives: To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), reference lists of articles and abstracts from conference proceedings without language restriction. Selection criteria: RCTs comparing ESWL with ureteroscopic retrieval of ureteric stones were included. Participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered. Data collection and analysis: Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Main results: Five RCTs (732 patients) were included. The stone-free rates were lower in the ESWL group (RR 0.83 95% CI 0.70 to 0.98). The retreatment rates were lower but not significant in the ureteroscopy group (RR 2.78 95% CI 0.53 to 14.71). The rate of complications was lower in the ESWL group (RR 0.44 95% CI 0.21 to 0.92). Length of hospital stay was less for ESWL treatment (MD -2.10 95% CI -2.55 to -1.64). Authors' conclusions: Ureteroscopic removal of ureteral stones achieves a higher stone-free state but with a higher complication rate and a longer hospital stay.