Ultrasonography is not Inferior to Fluoroscopy to Guide in Extracorporeal Shock Waves for Treatment of Renal and Upper Ureteral Calculi

Abstract

Background : Extracorporeal shock wave lithotripsy (ESWL) is the standard treatment for urinary stones, which mainly uses fluoroscopy to determine the location of stones. Developing using ultrasound to determine the location of stones instead of traditional methods will be useful so that patients and doctors do not have to be exposed to X-rays from the use of fluoroscopy.Objective : To compare the efficacy and safety of ultrasound and fluoroscopy to guide in extracorporeal shock wave for treatment of renal and upper ureteral calculi.Methods : This study was a single-center study, randomized, non-inferiority trial in 154 patients who had radiopaque renal and upper ureteral calculi. Patients were randomly assigned to an ultrasound or fluoroscopy-guided SWL group. A standardized SWL protocol was used. The stone-free rate and the complications were compared.Results : Stone size and location, age, and body mass index were comparable between groups. The stone-free rate was 80.5% in the ultrasoundguided group compared to 81.8% in the fluoroscopy-guided group (p = 0.837). These results were not significantly different and proved to be non-inferior based (p = 0.037). The complication rate (gross hematuria) was 31.6% in the ultrasound-guided group compared to 38.2% in the fluoroscopy-guided group (p = 0.395). No patients had serious complications.Conclusions : Our study demonstrated that the clinical results of ultrasound-guided SWL were not inferior to the effects of fluoroscopy-guided SWL, while no ionizing radiation is needed.