Resorlu B et al, 2012: Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, Sancaktutar AA, Tepeler A, Bozkurt OF, Oztuna D
OBJECTIVES: To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10–20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications.
PATIENTS AND METHODS: A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments\3 mm. The success rates, auxiliary procedures, and complications were compared in each group.
RESULTS: Success rates were 66.5, 91.4, and 87 % for SWL, PNL, and RIRS (p\0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7 %, respectively; p\0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9 %, respectively (p\0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p\0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively).
CONCLUSIONS: For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.
World J Urol. 2012 Nov 22. [Epub ahead of print]
PMID: 23179732[PubMed - as supplied by publisher]
As in numerous other comparative studies between different stone removing procedures also this study shows that the success rate with SWL was lower (66%) than that with PNL (91%) and RIRS (87%). Different selection criteria were used for referring the patients to each treatment modality in this retrospective multicentre analysis. The authors have used disintegration to disintegration to reports the price to be paid for the higher success rates is the associated risk of complications: 8, 11 and 22% for SWL, RIRS and PNL. In summary this retrospective study brings little new information.