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Re-Treatment after Ureteroscopy and Shock Wave Lithotripsy: A Population Based Comparative Effectiveness Study
Diana K Bowen1, Lihai Song2, Jen Faerber2
1Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The Journal of Urology
|December 21, 2019
Summary
Shock wave lithotripsy (SWL) has a higher re-treatment rate than ureteroscopy for kidney stones. SWL showed a 20% increased odds of re-treatment, impacting treatment decisions for nephrolithiasis.
Area of Science:
- Urology
- Nephrology
- Health Services Research
Background:
- Shock wave lithotripsy (SWL) and ureteroscopy are common procedures for kidney and ureteral stones.
- Comparative effectiveness of SWL versus ureteroscopy at a population level remains unclear.
Purpose of the Study:
- To compare the re-treatment rates of SWL and ureteroscopy for kidney and ureteral stones.
Main Methods:
- Retrospective cohort study of 136,152 SWL or ureteroscopy surgeries from 1997-2016 in South Carolina.
- Primary outcome: re-treatment within 6 months.
- Propensity score matching and logistic regression models were used to compare outcomes.
Main Results:
- SWL was associated with a 20% increased odds of re-treatment compared to ureteroscopy (OR 1.20).
- Re-treatment probability was 10.4% for SWL versus 7.5% for ureteroscopy.
- SWL showed the highest risk of re-treatment at 2 and 3 months post-procedure.
Conclusions:
- SWL is associated with increased odds of re-treatment compared to ureteroscopy.
- Findings have implications for shared decision-making and value-based treatment of nephrolithiasis.
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