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Gadelkareem RA. et al., 2020: Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study

Gadelkareem RA, Abdelsalam YM, Ibraheim MA, Reda A, Sayed MA, El-Azab AS.J.
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Urology, Armed Forces Medical Complex, Cairo, Egypt.

Abstract

Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p = 0.723), with a higher rate of auxiliary procedures after SWL (p = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group (p = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively (p = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.
Endourol. 2020 Sep 7. doi: 10.1089/end.2020.0288. Online ahead of print. PMID: 32668990. FREE ARTICLE

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Commenti 1

Hans-Göran Tiselius il Lunedì, 01 Febbraio 2021 08:22

This report is of great interest inasmuch as most guidelines and experts consider patients with stones measuring 20-30 mm as poor candidates for treatment with SWL. In a randomized prospective study the authors analyzed results in 40 patients primarily treated with PNL or SWL

https://www.storzmedical.com/images/blog/Gadelkareem.JPG

Although secondary (auxiliary) sessions were more common after SWL most of the procedures were repeated SWL.There was no significant difference in SFR after 3 months
Advantages of SWL: non-invasive method, outpatient procedure and lower cost.
I was personally surprised that higher grades of complications were recorded following SWL!

Hans-Göran Tiselius

This report is of great interest inasmuch as most guidelines and experts consider patients with stones measuring 20-30 mm as poor candidates for treatment with SWL. In a randomized prospective study the authors analyzed results in 40 patients primarily treated with PNL or SWL [img]https://www.storzmedical.com/images/blog/Gadelkareem.JPG[/img] Although secondary (auxiliary) sessions were more common after SWL most of the procedures were repeated SWL.There was no significant difference in SFR after 3 months Advantages of SWL: non-invasive method, outpatient procedure and lower cost. I was personally surprised that higher grades of complications were recorded following SWL! Hans-Göran Tiselius
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Venerdì, 23 Aprile 2021

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