He XZ et al, 2017: Analysis of the safety and efficacy of combined extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for the treatment of complex renal calculus
He XZ, Ou TW, Cui X, Li J, Wang SH.
Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.
OBJECTIVE: To investigate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) combined with percutaneous nephrolithotomy (PCNL) for treatment of complex renal calculus.
PATIENTS AND METHODS: Seventy-eight patients diagnosed with complex renal calculus and who accepted treatment in our hospital were consecutively selected. Patients were divided randomly into the observation group (n=40) treated by combined ESWL and PCNL and the control group (n=38) treated by PCNL. The effect of treatment between the two groups was compared.
RESULTS: The stone-free rate at 3 months after surgery was higher in the observation group than in the control group. There were no differences in the rates of complications (including infection, hemorrhage, collection system perforation and laceration, peripheral organ impairment, and urination extravasation). There were gradual decreases of serum creatinine in the observation group at 4 weeks after extubation of the double J catheter and at 3 months after surgery, while there were no apparent decreases in the control group. The levels of cysteine protease inhibitor and neutrophil gelatinase-associated lipocalin in both groups increased at 4 weeks after extubation of the double J catheter, and decreased at 3 months after surgery. The decreases were more apparent in the observation group compared with the control group, and the differences were statistically significant (p<0.05).
CONCLUSIONS: Combined use of ESWL and PCNL to treat complex renal calculus can improve the stone-free rate and renal function, and does not increase the complication rate. It is, therefore, safe and effective.
Eur Rev Med Pharmacol Sci. 2017 Jun;21(11):2567-2571
This article on treatment of large and complex renal stones is interesting inasmuch as PCNL (control group) treatment alone was compared with combined SWL+PCNL treatment. It should be noted that in this study SWL was carried out before PCNL and not as in several previous studies after PCNL.
Interestingly the combined SWL+PCNL approach resulted in a significantly better stone-free rate (90%) than when PCNL was used alone (71%). It had of course been interesting to see what a PCNL+SWL combination with SWL given after PCNL had accomplished.
The details of SWL are sparsely reported and there is no information about stone composition. Nevertheless I find the report noteworthy and believe that the combined approach might improve stone-free rates in certain patients with complex stones.