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Gultekin MH et al, 2017: Does previous open renal stone surgery affect the outcome of SWL treatment in adults with renal stones?

Gultekin MH, Turegun FA, Ozkan B, Tulu B, Gulec GG, Tansu N, Demirdag C, Kendigelen P, Erozenci A, Onal B.
Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey.
epartment of Urology, Acıbadem University School of Medicine, Istanbul, Turkey.
Department of Anesthesiology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey.

Abstract

PURPOSE: To evaluate the effects of previous ipsilateral open renal stone surgery (ORSS) on outcomes of extracorporeal shockwave lithotripsy (SWL) in adults with renal stones.
MATERIAL AND METHODS: A total of 2097 renal units (RUs) with renal stones underwent SWL treatment at our institution between March 1997 and February 2013. 1839 (87.7%) of these had no history of ORSS and were categorized as group 1 and 258 (12.3 %) patients having previous history of ipsilateral ORSS were categorized as group 2. Characteristics of patients, stone and treatment, stone-free, and complications rates were documented in detail and compared in each group. These groups were also sub-classified into 4 subgroups according to the stone location.
RESULTS: The stone-free rates were statistically higher in group 1 than group 2 (73.2% and 61.6%, respectively). There were no differences between groups regarding the complications and steinstrasse. The stone-free rate of SWL for stones located at lower calyx has significant difference according to groups 1 and 2 (64 % vs 48.4 %, p=0.001). Logistic regression analysis showed that previous history of ORSS increased SWL failure rate 1.39 times.
CONCLUSION: Overall stone-free rates after SWL treatment was found to be significantly lower in patients with the history of previous ORSS than in patients without, and this finding was significantly prominent for lower calyx stones. We believe that RIRS or mini/micro PCNL, despite its possible difficulties in accessing due to anatomical changes, might be a good alternative for SWL.

J Endourol. 2017 Sep 11. doi: 10.1089/end.2017.0473. [Epub ahead of print]

 

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Comments 1

Peter Alken on Sunday, 21 January 2018 11:41

An exceptional series of 2097 cases treated by a single urologist specialized in SWL. The message I take is that the ESWL success rate of lower pole stones is smaller after previous surgery but still close to 50 %. Unfortunately no information is given on the kind of previous surgery, how to select these patients and what procedure - RIRS or PNL - was finally successful.

An exceptional series of 2097 cases treated by a single urologist specialized in SWL. The message I take is that the ESWL success rate of lower pole stones is smaller after previous surgery but still close to 50 %. Unfortunately no information is given on the kind of previous surgery, how to select these patients and what procedure - RIRS or PNL - was finally successful.
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