Elawady HMH. et al., 2025: Modalities of management of residual upper calyceal stones after percutaneous nephrolithotomy for staghorn stone: A randomized controlled trial.
Hossam Mohamed Hafez Elawady 1, Wael Ali Maged 1, Mostafa Mabrouk Bayoumi Aly Wahba 2, Ahmed Tawfick Hassan 1, Mahmoud Ahmed Mahmoud 1
1Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2Urology Department, Air Forces General Hospital, Cairo, Egypt.
Abstract
Background: This study assessed the safety and efficacy of management strategies for residual upper calyceal stones (1-2 cm) following percutaneous nephrolithotomy for staghorn calculi, comparing conservative management to interventional approaches.
Methods: A randomized trial included 105 patients with residual stones, assigned to flexible ureterorenoscopic laser lithotripsy (Group A), extracorporeal shock wave lithotripsy (ESWL, Group B), or conservative management (Group C). Outcomes included the need for additional interventions, stone-free rates, complications, and cost-effectiveness. Patients were followed for 1 year to assess pain, hematuria, hospital readmission, and stone clearance.
Results: Conservative management led to a 20% intervention rate within a year, primarily due to pain, obstruction, or patient preference. A stone size ⩽ 1.4 cm predicted the likelihood of intervention. Flexible ureterorenoscopy had the highest stone-free rate (94.29%), followed by ESWL (71.43%, p = 0.023). ESWL was the most cost-effective option (10.17 × 10³ vs 39.47 × 10³ Egyptian pounds, p < 0.001) but was less effective for high-density stones.
Conclusions: While conservative management avoids immediate intervention, it carries a higher risk of future complications and delayed interventions. Early intervention with flexible ureterorenoscopy or ESWL offers better long-term outcomes, with ESWL being the most cost-effective option.
Urologia. 2025 Jul 7:3915603251351069. doi: 10.1177/03915603251351069. Epub ahead of print. PMID: 40619932
Comments 1
A very simple, prospective, randomized study on an interesting, rarely discussed topic. As is so often the case with cost figures, the data are unfortunately difficult to assess. 10 × 10³ or 40 × 10³ Egyptian pounds correspond to €180 and €720, respectively, which is very inexpensive. However, information is lacking as to whether this refers to a single procedure or the entire retreatment of a single patient, whether the figures are based on reimbursements or actual costs, and what exactly was included.
Peter Alken