Wankhade NH et al, 2014: Comparative Study of Lithotripsy and PCNL for 11-15 mm Lower Caliceal Calculi In Community Health Hospital.
Wankhade NH, Gadekar J, Shinde BB, Tatte JA
Consultant, Department of Urology, Wankhade Kidney Hospital , Opposite Tarakpur S.T. Stand, Ahmednagar, Maharashtra, India.
Professor, Department of Surgery, Padam Shri Dr.V.V.P. Medical College , Ahmednagar, Maharashtra, India .
Professor, Department of Pathology, P.Dr.V.V.P. Medical College , Ahmednagar, Maharashtra, India.
Consultant, Department of Anesthesia, Wankhade Kidney Hospital , Opposite Tarakpur S.T. Stand, Ahmednagar, Maharashtra, India.
BACKGROUND AND PURPOSE: Percutaneous Nephrolithotomy (PCNL) is not a popular procedure in smaller sized calculi due to its invasive nature, complications and need for anesthesia. Small sized lower caliceal calculi are generally treated by ESWL but have significantly less clearance rate in spite of several sittings. Here we want to study the efficacy and safe of both procedures in 11 to 15 mm lower caliceal calculi. MATERIALS AND METHODS: We present comparative study of lithotripsy and PCNL in 11-15 mm lower caliceal calculi in our hospital. Total 156 patients were studied 78 underwent lithotripsy and 78 underwent PCNL. We compared results in the form of clearance rate, the number of settings needed, hospital stay, need for anesthesia, blood transfusion rate, chest complication, the incidence of sepsis, the need for another procedure, need for stenting in either group. RESULTS: We found a 67.95% clearance rate in SWL group and 97.43% clearance rate in PCNL group. Hospital stay was minimum in SWL group and was 46 hours in PCNL group. The procedure time was 42 minutes in PCNL and it was 114 mins in SWL (considering all settings). The rest of the complications like chest complication, sepsis and bleeding were negligible due to the small size of calculi. CONCLUSION: In a small sized LPC calculi, PCNL is gaining increased popularity due to lower complication and high safety and complete clearance rate. It is wide accepted by society as the patient is totally stone free at the end of the procedure. SWL is less invasive but less effective and has given significant discomfort to patients.
J Clin Diagn Res. 2014 Jun;8(6):HC12-4. doi: 10.7860/JCDR/2014/6704.4502. Epub 2014 Jun 20. FREE ARTICLE
That PNL results in a better stone clearance than SWL is well recognized and this report is no exception. There is, however, a price that must be paid for such an outcome. One of the most important advantages of non-invasive procedures is that they can be completed without anaesthesia. The extent of dissatisfaction expressed by the patients does at least partly reflect the dissatisfaction by the operator.
Also the EAU guideline document recommends consideration of invasive procedures for lower calyx stones with a diameter exceeding 10 mm. It is of note, however, that residual fragments found in the lower calices also come from stones disintegrated elsewhere in the collecting system (other calyces and renal pelvis).
One important research line would be to elucidate how the contractility of the lower calyces is affected by the distension caused by large stones, in order to find pharmacological agents to re-establish a normal calyx contraction after stone disintegration. If such a possibility becomes available its combination with inversion therapy would dramatically increase the success with SWL of stones in the lower calyx.