Comparison of Ureteroscopy (URS) Complementary Treatment after Extracorporeal Shock Wave Lithotripsy Failure with Primary URS Lithotripsy with Holmium Laser Treatment for Proximal Ureteral Stones Larger than 10mm

Background: To compare ureteroscopy (URS) complementary treatment following extracorporeal shock wave lithotripsy (SWL) failure with primary URS lithotripsy for proximal ureteral stones ＞ 10 mm, and try to find out optimal SWL session followed by safe URS. Methods: : This was a retrospective study following approval from Medical Ethics Committee of People's Hospital of Chongqing Banan District . Patients (n=340) who received URS in our hospital for stones ＞10 mm from Jan 2015 to June 2020 were divided into two groups according to their previous SWL history. Group 1 consisted of 160 patients that underwent unsuccessful SWL before URS. Group 2 encompassed 180 patients without SWL before URS. Patient’s operative outcomes were compared. Receiver operator characteristics were used to identify the optimal SWL session, regarding the intra-operative complications of URS. Results: : The group 1 required more surgery time (41.38 ± 11.39 min vs. 36.43 ± 13.36 min, P=0.01). At the same time, more intra-operative (68.1% VS 22.8%, p = 0.000) and post-operative (35% VS 18.0%, p = 0.001) complications occurred in group 1. Need more hospital stay in group 1 (2.7 ± 1.2 days vs 1.6 ± 1.1 days, p < 0.05). More patients in group 1 need further URS (16.3% VS 6.7%, p = 0.004). After second URS, the SFR of URS was insignificant differences (82.5% VS 88.9%, p＞ 0.05). The median (25% - 75%) of SWL sessions before URS was 2(1-3) in group 1. The optimal SWL session followed by URS were 0.5 (Area Under Curve = 0.718, p ＜ 0.001) with a sensitivity of 67.7% and specificity of 71.5%. Intra-operative complication rates of URS treatment were higher in patients who suffered ＞ 1 SWL failure (72.6% vs 57.4%, p = 0.047). Conclusion: There was no optimal SWL session that could be followed by URS with fewer intra-operative complications. Patients who underwent previous SWL were likely to suffer more intra-operative complications, the average operating time, hospitalization time, and needing further treatment, during URS treatment for proximal ureteral stones larger than 10 mm.