Shock wave lithotripsy versus ureteroscopy for ureteral calculi: a prospective assessment of patient-reported outcomes

Objective

To compare patient-reported outcomes (PROs) with objective outcomes after shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) for ureteral calculi (UC).

Methods

We prospectively evaluated 160 consecutive patients who underwent SWL (n = 65) or URS (n = 95) for a single radiopaque UC ranging from 4 to 15 mm. For patients who underwent URS, a 6-Fr double-J stent was routinely placed for 2 weeks after surgery. To examine PRO, we used a self-administered nonvalidated questionnaire evaluating overall satisfaction and PRO in four domains (pain, hematuria, voiding symptom, and time to return to routine activity) and willingness to undergo the treatment procedure again. Propensity-score matching analysis was performed to adjust for potential confounding by discrepancy of pretreatment parameters between groups. Stone-free rates (SFRs) and complications were also compared.

Results

SFRs after the first, second, and third sessions of SWL were 61.5, 81.0, and 93.5 %, respectively. SFR after URS was 100 %, which was significantly better than SFRs for third-session SWL (p = 0.023). Complications were comparable. By propensity-score matching analysis, overall satisfaction was similar between groups, whereas PRO for voiding symptom and time to return to routine activity were significantly better in the SWL group (all p < 0.05). The two groups were not different in willingness to undergo the same procedure again.

Conclusions

Despite significantly higher SFR after URS for UC, overall patient satisfaction was comparable after SWL and URS, meanwhile PRO of the SWL group was better than URS for voiding symptom and time to return to routine activity. In addition of objective treatment outcomes, PROs should be considered in counseling treatment methods for UC.