Flexible Ureteroscopy versus Shock Wave Lithotripsy for the Treatment of Renal Stones Measuring 1 to 2 Centimeters: A Systematic Review

Abstract

Introduction: The management of intermediate-sized (1-2 cm) renal stones is a common clinical challenge. The primary treatment options are minimally invasive procedures: shock wave lithotripsy (SWL) and flexible ureteroscopy (fURS) with laser lithotripsy. This review compares the efficacy and safety of these two modalities.

Methods: A systematic search of several electronic databases was performed for RCTs comparing fURS to SWL for solitary renal stones between 1 and 2 cm. The primary outcome was the stone-free rate (SFR) after a single procedure. Secondary outcomes included the need for auxiliary procedures and complication rates.

Results: The meta-analysis of 15 RCTs demonstrated that fURS resulted in a significantly higher single-procedure SFR compared to SWL. Patients treated with SWL required more auxiliary procedures and re-treatments to achieve a stone-free status. While fURS was more invasive and had a higher rate of minor complications (e.g., postoperative pain, transient hematuria), major complication rates were low and comparable for both.

Discussion: fURS offers a more definitive and efficient treatment in a single session for intermediate-sized renal stones. The choice between fURS and the less invasive SWL should be based on patient factors, stone characteristics (e.g., density), and shared decision-making regarding the trade-off between single-procedure success and invasiveness.

Conclusion: For renal stones of 1 to 2 cm, flexible ureteroscopy provides a significantly higher single-procedure stone-free rate than shock wave lithotripsy.