Kadir Karkin et al., 2024: Which Method Is More Effective for the Treatment of 1-2 cm Renal Pelvis Stones in Obese Patients: Extracorporeal Shock Wave Therapy or Flexible Ureterorenoscopy?
Kadir Karkin, Mubariz Aydamirov, Buğra Aksay, Eyüp Kaplan, Güçlü Gürlen
Department of Urology, Health Sciences University, Adana City Training And Research Hospital Urology Clinic, Adana, TUR.
Department of Urology, Başkent University, Alanya Application and Research Center, Antalya, TUR.
Department of Urology, Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, TUR.
Department of Urology, Abdulkadir Yüksel State Hospital Urology Clinic, Gaziantep, TUR.
Abstract
Objective: This study aimed to compare the clinical outcomes and complications of obese patients who underwent extracorporeal shock wave lithotripsy (ESWL) and flexible ureterorenoscopy (FURS) for treating 1-2 cm renal pelvic stones.
Methods: This study included 89 patients with a body mass index (BMI) >30 who underwent ESWL and FURS surgeries for 10-20 mm renal pelvic stones between January 2015 and July 2023. Three months after the treatments, patients underwent full abdominal computed tomography (CT) and were examined for stone-free status and the presence of residual stones. The presence of ≥4 mm residual stones on imaging was considered a failure, and these patients were treated again. Demographic data, stone characteristics, stone-free rate (SFR) three months after the procedure, surgery/procedure time, and complications such as bleeding, urosepsis, and collecting system perforation were compared between the groups.
Results: The patients included in the study were divided into two groups: ESWL (n=46) and FURS (n=43). Demographic and clinical data were similar between the groups. Retreatment rates were higher in the ESWL group compared to the FURS group. The mean procedure time was similar between the groups (p=0.085). The three-month SFR was found to be higher in the FURS group (88.3% vs. 73.9%; p=0.043). There was no difference in complication rates between groups.
Conclusion: FURS is a more effective treatment method than ESWL in obese patients with stones 1-2 cm in size located in the renal pelvis.
Cureus. 2024 Feb 14;16(2):e54194. doi: 10.7759/cureus.54194. eCollection 2024 Feb.
PMID: 38496118 PMCID: PMC10942129 DOI: 10.7759/cureus.54194 FREE FULL TEXT
Comments 1
The authors name the study limitations. “The main limitations are the small number of patients, the study being conducted retrospectively, and the lack of cost analysis, subgroup analysis of obese patients, skin-stone, distance measurements, stone analysis results, information about analgesic use between groups, and pain score examination.”
Patients for this retrospective study were collected during a long time period
between January 2015 and July 2023 in 3 different clinics according to the affiliation of the authors. It is not stated how the patients were selected. Why was none of the many ROC curves published to predict ESWL failure and success applied to select the patients? I would have liked to have seen the influence of this bias on the result.
Peter Alken