Selmi V et al, 2018: Does Previous Failed Shockwave Lithotripsy Treatment Have an Influence on Retrograde Intrarenal Surgery Outcome?
Selmi V, Sarı S, Çakıcı MÇ, Özdemir H, Kartal İG, Özok HU, İmamoğlu MA.
Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey.
Department of Urology, Goztepe Training and Research Hospital, Faculty of Medicine, Medeniyet University, İstanbul, Turkey.
Department of Urology, Avcılar State Hospital, İstanbul, Turkey.
Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Department of Urology, Faculty of Medicine, Karabük University, Karabük, Turkey.
Abstract
BACKGROUND: The prevalence of urolithiasis is nearly 20% and patients with urolithiasis constitute an essential part of the patients referred to the urology clinic. Many parameters should be considered for the management of renal stones and authors recommend extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PNL), as treatment options. Among these techniques, SWL does not require general anesthesia, has 89% success rate for renal pelvic stones: 83% for upper caliceal stones, 84% for middle caliceal stones, and 68% for lower caliceal stones. In this study, we aimed to investigate whether the previously failed SWL treatment affects RIRS outcome.
METHODS: Patients who underwent RIRS for kidney stones between January 2012 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital were reviewed retrospectively. Patients treated with primary RIRS (186 patients) were classified as Group 1. The outcomes of these patients were compared with those of 186 patients who underwent RIRS after failed SWL treatment using matched-pair analysis, and these patients were classified as Group 2.
RESULTS: The procedure success was defined as the sum of the stone-free and clinically insignificant residual fragments (CIRFs); final success rates were 90.3% and 91.9%, respectively. If we compare the final success rates, there was no statistically significant difference between both groups (P = .584).
CONCLUSIONS: As a result, there is no negative effect of the previous unsuccessful SWL treatment on the RIRS success. Patients with CIRF should be followed up more carefully in terms of becoming symptomatic.
J Laparoendosc Adv Surg Tech A. 2018 Nov 10. doi: 10.1089/lap.2018.0487. [Epub ahead of print]
Comments 1
The conclusion drawn from this study was that compared with primary RIRS, RIRS following unsuccessful SWL did not affect the treatment outcome negatively. As in most other studies of this kind the authors suggest additional prospective studies. In this case such a step might be particularly relevant because the percentage of patients with stones in the lower calyx was much lower than expected.