Hassan M et al, 2015: Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.
Hassan M, El-Nahas AR, Sheir KZ, El-Tabey NA, El-Assmy AM, Elshal AM, Shokeir AA.
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
OBJECTIVE: To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone.
PATIENTS AND METHODS: The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20-81) years. The patients' criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared.
RESULTS: In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001).
CONCLUSIONS: PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.
Arab J Urol. 2015 Sep;13(3):212-6. doi: 10.1016/j.aju.2015.04.002. Epub 2015 Jun 6.
This paper from a good institution on the treatment of single pelvic stones unfortunately is a retrospective study. Inclusion of data on costs is important and rarely done. “The cost of PNL for each patient was US$ 1,143 and for ESWL was US$ 357 for the first session and $70 for subsequent sessions. The cost of ureteroscopy was US$ 570 and of JJ ureteric stenting was US$ 285.” But the authors fail to indicate how the costs were evaluated and it is difficult to understand how the median cost for PNL of the whole series of 1120 US$ could be lower than the cost of 1143 US$ for a single patient.
See also: Wu H, Wang J, Lu J, Wang Y, Niu Z. Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy. Urol Int. 2015 Nov 10. They give hints on how to estimate the probability of ESWL success in larger stones.