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Gokce MI et al, 2016: Comparison of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) for treatment of stone disease in horseshoe kidney patients.

Gokce MI, Tokatli Z, Suer E, Hajiyev P, Akinci A, Esen B.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Department of Urology, Doruk Hospital Ankara, Turkey.

Abstract

OBJECTIVES: In this study it is aimed to compare the success and complication rates of SWL and RIRS in treatment of HSK stone disease.
MATERIALS AND METHODS: In this retrospective study data of 67 patients treated with either SWL (n=44) or RIRS (n=23) for stone disease in HSK between May 2003 to August 2014 was investigated. age, gender, stone size and multiplicity, stone free status, renal colic episodes and complication rates of the SWL and RIRS groups were compared.
RESULTS: Mean age of the population was 42.5±8.2 (range: 16-78) years and mean stone size was 16.9±4.1 mm. SWL and RIRS groups were similar with regard to demographic characteristics and stone related characteristics. SFR of the SWL and RIRS groups were 47.7%(21/44 patients) and 73.9% (17/23 patients) respectively (p=0.039). Renal colic episodes were observed in 3 and 16 patients in the RIRS and SWL groups respectively (p=0.024). No statistically significant complications were observed between the SWL (8/44 patients) and RIRS (4/23) groups (p=0.936).
CONCLUSIONS: In HSK patients with stone disease, both SWL and RIRS are effective and safe treatment modalities. However RIRS seems to maintain higher SFRs with comparable complication rates. 

Int Braz J Urol. 2016 Jan-Feb;42(1):96-100. doi: 10.1590/S1677-5538.IBJU.2015.0023.

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Comments 1

Hans-Göran Tiselius on Saturday, 15 October 2016 11:25

Removal of stones from horseshoe kidneys is a well recognized clinical problem. Although SWL can result in good disintegration, clearance of fragments is usually difficult because of the outflow anatomy.

In this retrospective analysis SWL and RIRS were compared in 67 patients. Of 52 stones in 44 patients treated with SWL and 32 stones in 23 patients treated with RIRS, the stone-free rates (defined as ≤ 3 mm fragments) were 48% and 74% respectively.

Exact information on the number of SWL-sessions is not given neither are stone composition nor stone surface area. In which position SWL was carried out had been interesting information. Such factors might explain differences in disintegration between the two groups.

Although stone-free rates were better with RIRS its invasiveness and need of anesthesia need to be taken into account.

It is my own opinion that if the urine outflow from the kidney seems to allow fragment passage and the stones can be placed in focus (which is not always the case in patients with horseshoe kidneys) it might be worthwhile to make a non-invasive attempt before changing to an invasive treatment modality.

Removal of stones from horseshoe kidneys is a well recognized clinical problem. Although SWL can result in good disintegration, clearance of fragments is usually difficult because of the outflow anatomy. In this retrospective analysis SWL and RIRS were compared in 67 patients. Of 52 stones in 44 patients treated with SWL and 32 stones in 23 patients treated with RIRS, the stone-free rates (defined as ≤ 3 mm fragments) were 48% and 74% respectively. Exact information on the number of SWL-sessions is not given neither are stone composition nor stone surface area. In which position SWL was carried out had been interesting information. Such factors might explain differences in disintegration between the two groups. Although stone-free rates were better with RIRS its invasiveness and need of anesthesia need to be taken into account. It is my own opinion that if the urine outflow from the kidney seems to allow fragment passage and the stones can be placed in focus (which is not always the case in patients with horseshoe kidneys) it might be worthwhile to make a non-invasive attempt before changing to an invasive treatment modality.
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