Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a mm Single Renal Pelvis Stone Authors: Mohammed Hassan, Ahmed R. EL-Nahas, Khaled Z. Sheir, Nasr A. El-Tabey, Ahmed M. El-Assmy and Ahmed A. Shokeir Affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
Aim of the study To compare the efficacy, safety and cost of extracorporeal shockwaves lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) in treatment of a mm single renal pelvis stone.
Patients and Methods Retrospective Study Between January 2006 and December 2012 Exclusion criteria: – –Patients aged <18 years, – –Branched stone – –Advanced hydronephrosis, – –Solitary kidney, anatomical renal abnormality – –Received treatment for this stone within the past 6 months.
In PNL group: –Prone position –Fluoroscopic guided renal puncture –Dilatation with Alken’s metal dilator to 30 F –Disintegrated: ultrasonic or pneumatic –A 22 F nephrostomy tube was placed and left for hours Patients and Methods
In SWL group: –Electromagnetic Dornier lithotripter S (Dornier MedTech GmbH, Germering, Germany) was used. –Shockwaves were delivered at a rate of 80 shocks/minutes till a maximum of 3000 shocks per session. Patients and Methods
Evaluation The stone free status was evaluated 3 months after PNL or last SWL session by NCCT. Success included patients who became stone free or had insignificant residual (4 mm or less). Comparison: The 2 groups were compared for: Re-treatment rate, secondary procedures The costs of primary and secondary procedures Patients and Methods
Results
SWL 167 Patients PNL 170 Patients P Patients characters Age (years) Mean ± SD47.7 ± ± BMI Mean ± SD31.6 ± ± Stone character Side Right Left 77 (46%) 90 (54%) 84 (49.4%) 86 (50.6%) Largest diameter (mm)23.5 ± ± 3< Stone surface area (mm 2 )295 ± ± 136< SSD (cm, mean ± SD)9.9 ± ± Attenuation value (HU)826 ± ±
SWL 167 Patients PNL 170 Patients P Efficacy N. (%) N. (%) Success 115 (75%)162 (95.3%) < Re-treatment 126 (75.4%)9 (5.3%) < Secondary procedure 42 (25%)8 (4.7%) < Results
SWL 167 Patients PNL 170 Patients P Safety N. (%) N. (%) Complications (Clavien Class.) overall G I G II G IIIa 11 (6.6) 0 (0) 4 (2.4) 7 (4.2) 22 (12.9) 7 (4.1) 6 (3.5) 9 (5.3) Total Cost ($US) < Median (Range) 490 ( ) 1120 ( ) Results
Conclusions For treatment of a single renal pelvis stone of mm: –PNL was more effective than SWL. –SWL had lesser complications and lower cost.