Kumar A et al, 2014: A prospective randomized comparison between Shock wave lithotripsy (SWL), Retrograde intrarenal surgery(RIRS) and miniperc for treatment of 1-2 cm radiolucent lower calyceal renal calculi :A single centre experience.
Kumar A, Kumar N, Vasudeva P, Jha SK, Kumar R, Singh H
Head of Department, Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, 110029, India
OBJECTIVES: A prospective randomized comparison of Shock wave lithotripsy(SWL), retrograde intrarenal surgery(RIRS) and miniperc for treatment of 1-2cm radiolucent lower calyceal renal calculi was done to evaluate safety and efficacy of these procedures. MATERIALS AND METHODS: Patients with 1-2cm single radiolucent lower calyceal renal stone, who underwent treatment between Jan 2012 and May 2013,
were included and randomized into 3 groups-1]SWL group, 2]RIRS group, 3]Miniperc group. Patient's demographic profile, success
rates, retreatment rates, auxiliary procedures and complications were analyzed. RESULTS: 45 patients were enrolled in each group, of which 3, 2 and 4 patients respectively, were excluded from final analysis with diagnosis of matrix stone. The mean procedure time and fluoroscopy time were significantly greater in Miniperc group compared to other groups. The hospital stay (3.1days vs 3.1hours
and 1.3days;p=0.01) and blood transfusion rate (13.3% vs 0 vs 0;p=0.03) were significantly higher in Miniperc group compared to SWL
and RIRS groups, respectively. The retreatment rate (63.4% vs 2.1% vs 2.2%,p<0.001) and auxiliary procedure rate (20.2% vs 8.8% vs 6.6%,p=0.02) were significantly greater in SWL group compared to RIRS and MIniperc group, respectively. The 3-month stone free rate for SWL, RIRS and Miniperc group was (31/42)73.8% vs (37/43)86.1% vs 39/41(95.1%),(p=0.01), respectively. CONCLUSIONS: For treatment of 1-2cm radiolucent lower calyceal renal calculi, miniperc and RIRS were more effective than SWL in terms of better stone free rate,
lesser auxiliary and retreatment rates. However, miniperc resulted in more complications, operating time, radiation exposure and hospital stay.
J Urol. 2014 Jul 24. pii: S0022-5347(14)04037-3. doi: 10.1016/j.juro.2014.07.088. [Epub ahead of print]
In this report the authors compare in a prospective, randomized study the results of SWL, RIRS and mini-PNL for treatment of radiolucent stones in the lower calyces. As stated by the authors the goal was to make patients “stone free with minimal complications”. In this regard it is surprising that oral dissolution was not considered as one treatment line, particularly in view of the fact that all stones accounted for were composed of 100% uric acid (when few matrix stones had been excluded).
Although it is emphasized that RIRS and mini-PNL procedures were carried out by one experienced consultant urologist, nothing is mentioned about the experience of the SWL operator(s).
Moreover, I am personally surprised that it was possible to complete SWL with only skin application of an analgesic cream. Did the authors use particularly low energy levels?
Although matrix stones were not included it is of note that they comprised as many as 5.6%.