The present study was conducted in a prospective manner according to the Helsinki Declaration between July 2018 and July2021. The study period was planned as three years. Patients who had DUS stone smaller than 1.5 cm were accepted as candidates for the study. The diagnosis of ureteral stones in all patients was made by non-contrast computed tomography (CT) of the abdomen and pelvis. The longest diameter measured on CT was accepted as the stone size. All patients had not received any prior treatment for the same stone. Type of treatment modality was chosen by the joint decision of the patient and the surgeon. All URS operations and SWL procedures were performed by the same surgeon. Patients with concomitant kidney stone, patients who underwent URS in emergency situation, and patients with JJ stent and/or nephrostomy tube were excluded from the study. Moreover, other exclusion criteria were presence of bilateral ureteral stone, patients aged < 18 years, and inability to complete the SF-36 form.
Preoperative patient characteristics (age, sex, body mass index (BMI), comorbidities, previous stone surgery) and stone-related parameters (stone size, stone opacity and stone side) were recorded. Also, hospitalisation period, post procedural analgesia requirements, stone-free status and complications were noted. Success was defined as no stone fragment on kidney-ureter-bladder graphy and urinary ultrasonography three week after the procedure. Also, the SF-36 form was completed one day before the procedure and one month after the procedure. Patients were divided into three groups according to treatment modality as SWL, only URS and URS including JJ stent insertion. Groups were compared according to preoperative data, treatment results and SF-36 form outcomes.
URS and SWL technique
All URS procedures were performed in under general anaesthesia. First cystoscopy was performed and a safety guide wire was inserted into the ureter. Then, an 8 F ureterorenoscope (Karl- Storz, Tuttlingen, Germany) was inserted into the ureter, and stone fragmentation was done with holmium laser. Stone fragments were extracted with a nitinol basket. The JJ stent was inserted in cases with solitary kidney, patients with chronic kidney disease, distal ureteral stenosis or ureteral injury.
SWL treatment was done using the Dornier Compact Sigma (Dornier MedTech GmbH, Wessling, Germany) in supine position. Intramuscular analgesic was applied 30 min before the procedure, and SWL was performed with the following settings: 1500–3000 impulses, 100/150 pulses/min, and energy, 8–12 J per session.
SF-36 form
The SF-36 is a self-reported questionnaire to evaluate physical functioning and well-being [6]. The survey contains three domains about physical functioning, three domains about emotional functioning, one domain related to pain, and one domain associated with general health. The SF-36 form was filled one day before the procedure and one month after the procedure. Each scale is directly converted into a 0–100 scale on the supposition that each question carries equal weight. Higher scores are associated with less disability.
Statistical analysis
Statistical analysis was done with the Statistical Package for the Social Sciences version 20 (SPSS IBM Corp., Armonk, NY, USA). Normality of distribution of the variables was evaluated by the Shapiro–Wilk test and Q-Q plots. The ANOVA test was used for comparison of normally distributed parameters between three groups, and the Kruskal–Wallis test was used for non-normally distributed parameters. For post hoc analysis to compute pairwise comparisons, Tukey test and Games-Howell test were used. Categorical variables were categorized and assessed using the χ2 test or Fisher’s exact test. Quantitative data are presented as mean ± standard error values. The data were evaluated at 95% confidence level and P value of less than 0.05 was accepted as statistically significant.
