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Bas O et al, 2013: Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones

Bas O, Bakirtas H, Sener NC, Ozturk U, Tuygun C, Goktug HN, Imamoglu MA
Department of Urology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey


Abstract

To compare success and complication rates of shock wave lithotripsy (SWL), flexible ureterorenoscopy (F-URS) and percutaneous nephrolithotripsy (PNL) according to modified clavien grading system of renal pelvis stones between 1 and 2 cm. The results of 149 patients were evaluated retrospectively. Patients were divided into three groups as 52 for SWL, 47 for F-URS and 50 for PNL. Complications were evaluated by modified Clavien grading system. In the first group, stone-free rates after a mean of 2, 6 sessions was 86 % (45/52). In Group 2, this ratio was 91.4 % (43/47), and in Group 3, it was 98 % (49/50). The success rate in Group 3 was significantly higher than other groups. Complication rates for Group 1, 2 and 3 were 7.6 % (4/52), 6.3 % (3/47) and 12 % (6/50), respectively. Although PNL was the most successful technique compared with other techniques, complications were also higher in this group. Even though PNL is the most successful, it should be performed for selected patient groups and indications should be carefully evaluated.

Urolithiasis. 2013 Oct 27. [Epub ahead of print]
PMID:24162954[PubMed - as supplied by publisher]

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Comments 1

Peter Alken on Tuesday, 03 December 2013 09:27

This is a retrospective study. The "treatment method was chosen according to the surgeons' and patient's preference." One of the authors conclusion is: "There are no clear guideline recommendations for renal pelvis stones between 1 and 2 cm. This may be because of the lack of randomized controlled studies concerning SWL, F-URS and PNL methods." The study does not add anything new to what is already known about the subject except that the authors did it. A guideline panel would not consider this paper for evaluation.

I generally dislike papers which devalue their own findings by concluding: "... prospective randomized trials on larger cohorts are required to confirm these findings." because I think that most of them just contribute to the scientific noise.

Peter Alken

This is a retrospective study. The "treatment method was chosen according to the surgeons' and patient's preference." One of the authors conclusion is: "There are no clear guideline recommendations for renal pelvis stones between 1 and 2 cm. This may be because of the lack of randomized controlled studies concerning SWL, F-URS and PNL methods." The study does not add anything new to what is already known about the subject except that the authors did it. A guideline panel would not consider this paper for evaluation. I generally dislike papers which devalue their own findings by concluding: "... prospective randomized trials on larger cohorts are required to confirm these findings." because I think that most of them just contribute to the scientific noise. Peter Alken
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