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Radwan AI. et al., 2023: Comparative study between ultra-mini-percutaneous nephrolithotomy versus stented extracorporeal shock wave lithotripsy for treatment of renal stones in Egypt.

Radwan AI, Saif AMI, Samir YR, Maged WA, Gamal MA.
Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Objectives: The purpose of this study is to compare results, safety and outcome of ultra-mini-percutaneous nephrolithotomy (PCNL) versus stented shock wave lithotripsy (SWL) for the management of renal calculi sized 10-20 mm.

Methods: This study was conducted at Urology Department, Faculty of Medicine, Ain Shams University. After meeting inclusion and exclusion criteria, 90 patients were randomized to either ultra-mini-PCNL group or stented SWL group through the closed-envelope technique, with 45 patients in each group. Patient data were collected preoperatively, immediately postoperatively and 2 and 4 weeks postoperatively assessing operative time, hospital stay, complications including haematuria, fever, the need for blood transfusion, residual stones and the need for retreatment.

Results: Stone-free rate (SFR) was higher in the ultra-mini-PCNL group compared to the stented SWL group, with no statistically significant difference with P-value = 0.316. As for the need for retreatment, it was slightly higher in the stented SWL group compared to the ultra-mini-PCNL group, yet this difference was statistically insignificant with P-value = 0.681.We found no statistically significant difference between both groups regarding post-operative complications including fever, haematuria and need for blood transfusion, respectively.Operative time and hospital stay were significantly higher in the ultra-mini-PCNL group compared to the stented SWL group with P-value < 0.001 for both.

Conclusion: Both stented SWL and ultra-mini-PCNL are good treatment choices for renal stones sized less than 2 cm with low complication rates. Stone size indices were significant predictor for the need for retreatment. Further studies to compare SFR based on stone size in both interventions are needed.

Arab J Urol. 2023 May 16;21(4):273-279. doi: 10.1080/2090598X.2023.2211897. eCollection 2023.
PMID: 38178944 FREE PMC ARTICLE

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Comments 1

Hans-Göran Tiselius on Wednesday, 26 June 2024 11:00

The author of this study compared ultra-mini PCNL (UM-P) and stented SWL (SWL-S) in 45 patients of each group. The conclusion was that stone-free rates in UM-P treated patients was 88% compared with 80% in SWL-S patients. The instrument size in UM-P is 11-13 Fr and the stone size recorded in included patients was 10-20 mm (means 18.5 and 18.8 mm). It is not fully understood why SWL-treated patients had stents. Such a step might decrease rather than increase fragment disintegration and elimination in this stone-size range. In summary there was no significant difference in stone-free or re-treatment rates.
Both patient groups were treated under general anesthesia and stayed in the hospital 3-4 days for UM-P and 1-2 days for SWL-S. It is mentioned that expulsive therapy was used in SWL-treated patients. Re-treatment was necessary in in both groups, 12% and 15%, respectively.
It is difficult to compare the two methods in detail because the definition of stone-free included fragments

The author of this study compared ultra-mini PCNL (UM-P) and stented SWL (SWL-S) in 45 patients of each group. The conclusion was that stone-free rates in UM-P treated patients was 88% compared with 80% in SWL-S patients. The instrument size in UM-P is 11-13 Fr and the stone size recorded in included patients was 10-20 mm (means 18.5 and 18.8 mm). It is not fully understood why SWL-treated patients had stents. Such a step might decrease rather than increase fragment disintegration and elimination in this stone-size range. In summary there was no significant difference in stone-free or re-treatment rates. Both patient groups were treated under general anesthesia and stayed in the hospital 3-4 days for UM-P and 1-2 days for SWL-S. It is mentioned that expulsive therapy was used in SWL-treated patients. Re-treatment was necessary in in both groups, 12% and 15%, respectively. It is difficult to compare the two methods in detail because the definition of stone-free included fragments
Friday, 12 July 2024