“It’s a complicated issue. The numbers for ureteroscopy have increased dramatically since I started my practice, so it’s kind of happening whether we want it to or not.
Ureteroscopy has superior results to shock wave lithotripsy, and it’s improved over the years due to the improvement in ureteroscopes and the holmium laser and improved techniques. But shock wave lithotripsy still has reasonably good results and fewer complications for the patient, primarily related to not having to have a ureteral stent. It works well for a lot of patients, so it’s not something that should go away.
The funny thing is that I never really did shock wave lithotripsy. I trained with Dr. Demetrius Bagley, one of the founding fathers of ureteroscopy, so I was confident in my ability to treat patients ureteroscopically very early in the holmium laser era, and never felt as confident using shock wave lithotripsy. I’ve done thousands of ureteroscopies, but probably only a half-dozen shock wave lithotripsies. I’ve been arguing in favor of ureteroscopies for many years, but looking at the big picture I would say ESWL still serves many patients very well. Patient satisfaction is very high with it, and it shouldn’t be retired completely—even if I haven’t done one in more than a decade.
I’m better able to get patients stone free with ureteroscopy, so although they may have less discomfort with ESWL, the result will be better. But some urologists are still more comfortable with ESWL, and the instruments for ureteroscopy aren’t always available. Thinking about it more globally, we don’t want to remove a tool from our armamentarium.”
Michael Conlin, MD