Ibis MA. et al., 2023: What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients.
Ibis MA, Gokce MI, Gökhan O, Karagoz MA, Yitgin Y, Babayigit M, Böyük A, Verep S, Tefik T, Kiremit MC, Senocak C, Guven S, Sarica K.
Department of Urology, Ataturk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Department of Radiology, Private Biosan Polyclinic, Istanbul, Turkey.
Department of Urology, Prof. Dr. Cemil Tascıoglu City Hospital Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Urology, Istinye University School of Medicine, Istanbul, Turkey.
Department of Urology, Private Duygu Hospital, Istanbul, Turkey.
Department of Urology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey.
Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Urology, School of Medicine, Koc University, Istanbul, Turkey.
Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey.
Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
Background: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones. Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications. Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones. Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.
J Laparoendosc Adv Surg Tech A. 2023 Feb 24. doi: 10.1089/lap.2022.0513. Online ahead of print. PMID: 36827462
The purpose of this retrospective analysis of treatment data from eight Turkish centers, was to draw conclusions on results with SWL, RIRS, mPNL and stPNL. All treated stones had a size range between 20 and 30 mm and thus they were outside the common recommendations for SWL. The choice of treatment was based on the patient’s or the surgeon’s preference and accordingly there was a great variation in treatment modalities.
It is of note that SWL was carried out with piezoelectric lithotripsy!
The initial stone-free rates were as follows:
Moreover, it is stated that that RIRS as well as other invasive endoscopic procedures were considered as auxiliary treatments. But when RIRS is required after SWL, this is not an auxiliary procedure but a method necessary because of failed primary treatment. What is referred to as auxiliary procedures therefore was a “potpourri” of endoscopic procedures as follow-up after failure with the primary chosen treatment. This means that attempts to calculate for instance stone treatment indices was impossible.
The outcome of the treatment efforts is like what can be found in the modern literature and the report does not add any important new information. I would personally not have chosen piezoelectric lithotripsy for stones in this size category.