Ozturk U et al, 2013: Comparison of Percutaneous Nephrolithotomy, Shock Wave Lithotripsy, and Retrograde Intrarenal Surgery for Lower Pole Renal Calculi 10-20 mm
Ozturk U, Sener NC, Goktug HN, Nalbant I, Gucuk A, Imamoglu MA
Department of Urology, Ankara Dışkapı Yıldırım Beyazit Education and Research Hospital, Ankara, Turkey
OBJECTIVE: To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones.
PATIENTS AND METHODS: This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system.
RESULTS: The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05).
CONCLUSION: PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.
Urol Int. 2013;91(3):345-9. doi: 10.1159/000351136. Epub 2013 Jun 28
PMID:23816573[PubMed - in process]
If one compares the results of the present retrospective analysis with the well-known "Lower Pole -1 study" (Albala DM et al.: A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results.J Urol. 2001; 166:2072-80) and the subsequent "Lower Pole - 2 study" (Pearl M et al.: Prospective, Randomized Trial Comparing Shock Wave Lithotripsy and Ureteroscopy for Lower Pole Caliceal calculi 1 cm or less. J Urol 2005; 173: 2005-9) the progress that has been made becomes apparent but also the notoriously inferior SWL-results of the latter two studies. That sheds another doubt on the quality of the lower pole studies.
The author of the present study state: "Because of the lower number of complications of SWL and RIRS, these methods are good alternatives to PCNL. Compared with the excellent outcomes of PCNL, RIRS and SWL seem to have less successful outcomes, but with these good success/complication rates they are important contenders in the first-line treatment race. When choosing the treatment for this subgroup of stone patients, all advantages and disadvantages should be considered and the method should be carefully chosen." I fully agree.