Gadelkareem RA. et al., 2020: Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study
Gadelkareem RA, Abdelsalam YM, Ibraheim MA, Reda A, Sayed MA, El-Azab AS.J.
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Urology, Armed Forces Medical Complex, Cairo, Egypt.
Abstract
Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p = 0.723), with a higher rate of auxiliary procedures after SWL (p = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group (p = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively (p = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.
Endourol. 2020 Sep 7. doi: 10.1089/end.2020.0288. Online ahead of print. PMID: 32668990. FREE ARTICLE
Comments 1
This report is of great interest inasmuch as most guidelines and experts consider patients with stones measuring 20-30 mm as poor candidates for treatment with SWL. In a randomized prospective study the authors analyzed results in 40 patients primarily treated with PNL or SWL
Although secondary (auxiliary) sessions were more common after SWL most of the procedures were repeated SWL.There was no significant difference in SFR after 3 months
Advantages of SWL: non-invasive method, outpatient procedure and lower cost.
I was personally surprised that higher grades of complications were recorded following SWL!
Hans-Göran Tiselius