Comparative Study between Outcome of Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy in Patients with Renal Insufficiency

Abstract

Urolithiasis is a recognized precursor for renal deterioration. Moreover, if untreated, it can lead to renal failure. The prevalence of nephrolithiasis in patients with concomitant renal insufficiency is estimated to be 17.5%, it is a major public health problem and in the surgical setting not only are they at higher risk of anesthetic complications, but at greater risk of post-procedure complications (Kellett etal., 1991; Jones et al., 2017). In addition to achieving good stone clearance, surgical interventions employed in the treatment of stone disease must try to preserve maximal renal function (Kellett et al., 1991; Chandhoke et al1992). Management of nephrolithiasis in patients with renal insufficiency is therefore a difficult challenge for the endourologist as well as nephrologists and calls for careful consideration of the risks against the benefits, Multiple modularities can be used for various types of renal stones such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery (RIRS) and laparoscopic and/or robotic approaches(Nasir et al., 2014). Gunasekaran et al compared the long-term effects of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) on renal function with a solitary kidney and/or Abstract: Background: The incidence of stone formation in patients with renal insufficiency 17.5%, complete clearance of stone in these patients need least invasive procedure with safety of kidney parenchyma and kidney function. Objectives:To analyze outcomes of percutaneous nephrolithotomy (PNL) and shock wave lithotripsy (SWL) and their effect on kidney function for patients with renal insufficiency. Materials and methods: 52 renal insufficiency patients with renal stones presented to our department randomized into two groups group A (25 patients) underwent PNL and group B (27 patients) underwent SWL and all results recorded and analyzed with Statistical Package for Social Science ® (SPSS) and Microsoft Excel 2010. Results: Stone free rate was about 84% of patients in group A (25 patients) and about 26.6% of patients in group B with first session, while it`s about 88.9% for all patients in group B (27 patients) with some degree of improvement of kidney function. Conclusion: This study shows that both PNL and SWL are safe on patients with renal insufficiency with improvement of kidney function.