The natural history of failed shock wave lithotripsy: Redo-shock wave lithotripsy versus ureterorenoscopy and laser lithotripsy - A single-center comparative study in a university teaching hospital setting.

INTRODUCTION: Although the usage rates of ureterorenoscopy (URS) for treatment of urolithiasis have increased, extracorporeal shock wave lithotripsy (ESWL) remains a widely employed primary treatment option due to its less invasive character. However, in cases of primary ESWL failure, the optimal choice of secondary treatment, whether secondary ESWL (sESWL) or secondary URS (sURS) in terms of safety and efficacy, remains uncertain.

PATIENTS AND METHODS: A total of 62 urolithiasis patients who underwent sESWL (n = 31) or sURS (n = 31) at a single tertiary referral center between March 2014 and November 2019 were retrospectively analyzed. Key outcome parameters included tertiary reintervention rates, stone-free rates, and complication rates. Subgroup analyses were performed based on stone localization (kidney versus ureter) and stone size (<10 mm versus >10 mm).

RESULTS: Tertiary reintervention rates were significantly higher in the sESWL group (42%) compared to the sURS group (16%, P = 0.05). Stone-free rates at 6 weeks were lower in the sESWL group (29%) compared to the sURS group (84%, P < 0.01). Complication rates were 13% (4/31) in the sESWL group versus 6% (2/31) in the sURS group (P = 0.06).

CONCLUSION: sESWL is associated with a significantly higher rate of tertiary reintervention compared to sURS. However, in terms of safety, no statistically significant differences in complication rates between the two modalities were observed, and choice of tertiary treatment may therefore be made on individual discussion with the patients.