OBJECTIVES: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1-2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. PATIENTS AND METHODS: Between 2007 and 2011, 56 patients with lower calyceal stones 1-2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. RESULTS: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. CONCLUSION: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1-2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.
OBJECTIVES: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1-2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. PATIENTS AND METHODS: Between 2007 and 2011, 56 patients with lower calyceal stones 1-2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. RESULTS: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. CONCLUSION: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1-2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.
Authors: Doo Yong Chung; Dong Hyuk Kang; Kang Su Cho; Won Sik Jeong; Hae Do Jung; Jong Kyou Kwon; Seon Heui Lee; Joo Yong Lee Journal: PLoS One Date: 2019-02-21 Impact factor: 3.240