Resorlu B et al, 2016: Management of lower pole renal stones: the devil is in the details.
Resorlu B, Issi Y, Onem K, Germiyanoglu C.
Department of Urology, Ondokuz Mayis University, Faculty of Medicine, Samsun 55270, Turkey.
Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques.
Ann Transl Med. 2016 Mar;4(5):98. doi: 10.21037/atm.2016.03.02. FREE ARTICLE
The authors of this short comment discuss the results, advantages and disadvantages of SWL, RIRS and PNL for stones located in the lower calices. The differences in results are well described in the current literature. One part of the title tells the reader that “the devil is in the details”, this statement is valid in more aspects than those mentioned in this brief review.
Selection of the “best” treatment modality is described as controversial. This decision cannot be made only from the expected stone-free rates, it also has to be based on the balance between the goal of the treatment and the efforts and risks required to reach that goal.
In view of different grades of invasiveness, need of anaesthesia and rate of complications the choice of treatment is a delicate matter. The question that can be raised is if the advantage of an invasive treatment, to keep the number of procedures low or to avoid repeated sessions as far as possible, is superior to a treatment modality with higher need of repeated sessions but carried out in a convenient way at a lower cost and with fewer complications?
What the devil not always tells us is that when SWL is chosen, in similarity with endoscopic surgery, it should be carried out with great expertise in an optimal way and not, as so often is the case today, in a stereotypic and standardized way, with poorly educated operators. So, for stones located in the lower calyx consider the advantages and disadvantages of the treatment modality and do not let the devil be your guide.