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Singh BP et al, 2014: Retrograde Intrarenal Surgery vs Extracorporeal Shock Wave Lithotripsy for Intermediate Size Inferior Pole Calculi: A Prospective Assessment of Objective and Subjective Outcomes

Singh BP, Prakash J, Sankhwar SN, Dhakad U, Sankhwar PL, Goel A, Kumar M
Department of Urology, King George Medical University, Lucknow, India
Department of Rheumatology, King George Medical University, Lucknow, India
Department of Obstetrics and Gynecology, King George Medical University, Lucknow, India


Abstract

OBJECTIVE: To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion.

METHODS: Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared.

RESULTS: Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL.

CONCLUSION: For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.

Urology. 2014 Feb 20. pii: S0090-4295(13)01613-0. doi: 10.1016/j.urology.2013.12.026. [Epub ahead of print]
PMID:24560970[PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Monday, 10 February 2014 13:44

All patients treated with SWL were obviously treated with > 1 session and the total number of treatments were thus 47 (1.34). That only 34% became stone free is surprising. This might reflect that the operators(s) were not sufficiently experienced or that the lithotripter function was suboptimal. Such a situation might have influenced patients' opinion.

All patients in the RIRS group cannot be found in Table 2, only 32 of 35.

An approximate stone treatment index (STI; 1) calculated for the two groups gave values of 2.27 and 2.47 for SWL and RIRS, respectively. These figures thus show that taken together all treatment efforts relative to the treatment result were similar for the two groups.

Reference 1. Tiselius HG, Ringdén I.Stone treatment index: a mathematical summary of the procedure for removal of stones from the urinary tract.

J Endourol. 2007 21:1261-1269.

Hans-Göran Tiselius

All patients treated with SWL were obviously treated with > 1 session and the total number of treatments were thus 47 (1.34). That only 34% became stone free is surprising. This might reflect that the operators(s) were not sufficiently experienced or that the lithotripter function was suboptimal. Such a situation might have influenced patients' opinion. All patients in the RIRS group cannot be found in Table 2, only 32 of 35. An approximate stone treatment index (STI; 1) calculated for the two groups gave values of 2.27 and 2.47 for SWL and RIRS, respectively. These figures thus show that taken together all treatment efforts relative to the treatment result were similar for the two groups. Reference 1. Tiselius HG, Ringdén I.Stone treatment index: a mathematical summary of the procedure for removal of stones from the urinary tract. J Endourol. 2007 21:1261-1269. Hans-Göran Tiselius
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