The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size

Abstract

Introduction:Recently, few studies were reported about the treatment of large, solitary, renal calculi between shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL). We assess the feasibility of SWL for managing solitary, lower calyceal stones over 1 cm by comparing the results of lower pole calculi treatment between patients that underwent SWL or PNL. Methods: We retrospectively reviewed clinical data for patients who had undergone PNL or SWL due to lower calyceal stones over 1 cm. Group 1 consisted of patients who underwent SWL to treat lower pole renal calculi from 2010 to 2011. Group 2 included patients who underwent PNL to manage lower pole renal calculi from 2008 to 2009. We compared patient age, gender, stone size, comorbidities, postoperative complications, additional interventions and anatomical parameters between the two groups. Results: A total of 55 patients were enrolled in this study. The mean ages (±SD) of groups 1 (n = 33) and 2 (n = 22) were 55.1 (±13.0) and 50.0 (±10.6) years (p = 0.133) and mean stone sizes were 1.6 (±0.7) and 1.9 (±0.8) cm (p = 0.135), respectively. There were no significant differences in gender distribution, comorbidities or stone laterality between the two groups. No significant differences in various parameters were observed between patients with stones 1 to 2 cm and ones with stones 2 cm or larger. Conclusions: Our results demonstrated that SWL is a safe, feasible treatment for solitary, lower calyceal stones over 1 cm. IntroductionExtracorporeal shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) have been performed since the early 1980s to surgically treat patients with renal stones. Recently, retrograde ureteroscopic stone removal using a laser device was introduced following the technical development of devices.1 However, the management of larger renal calculi over 1 cm remains problematic and can be further complicated by the location of the stone, particularly ones in the lower pole calyx. Havel and colleagues demonstrated that PNL has better outcomes than SWL for solitary, lower pole calculus.2 May and colleagues reported that PNL is better than SWL for treating lower pole calyceal stones over 2 cm.3 Since then, Albala and colleagues reported the results of a comparison between SWL and PNL for treating lower pole calyceal stones. 4 They suggested poor stone-free clearance of SWL and introduced a technique for measuring various parameters related to lower calyx anatomy, such as lower pole infundibular length and width along with the lower pole infundibulopelvic angle. This group also suggested predictive values of these anatomical parameters for stone-free clearance. Chibber and colleagues emphasized the predominant effectiveness of PNL for managing lower pole calyceal stones 1 to 2 cm. 5Despite these findings, the use of PNL may be limited for the general population as this procedure involves invasive renal parenchymal puncture to access the renal calyceal stones, and should be performed under general anesthesia with the patie...

The Gachon University Ureteral Narrowing score: A comprehensive standardized system for predicting necessity of ureteral dilatation to treat proximal ureteral calculi

“…In addition, we defined 'C1' as density of the contralateral ureteral area, which was on the same level of 'U1.' We calculated anatomical parameters using coronal views of the CT scans, including stone size, stone density, skin-to-stone distance, and Hounsfield unit (HFU) of areas U1, U2, and C1 using a previously described method [ 4 5 6 ]. We designated 'UD' as the difference of HFU between U1 and U2.…”

Is Tubeless Percutaneous Nephrolithotomy a Feasible Technique for the Treatment of Staghorn Calculi?

“…Owing to its invasiveness by puncture of the renal parenchyme, postoperative complications after PNL have been reported [14,15]. Because of the noninvasiveness of SWL, many studies have supported the feasibility of SWL as an alternative to PNL [3,4]. Nonetheless, there is no doubt that PNL is still the standard method for the management of renal staghorn calculi [2,5].…”

“…Conventional and tubeless PNL were performed in the manner that we introduced previously [3]. Under general anesthesia, the patient's position was the lithotomy position.…”

“…Although some studies have reported better surgical outcomes for the management of renal calculi by use of shockwave lithotripsy (SWL) [3,4], PNL is still regarded as the standard treatment modality for management of renal calculi [5]. …”

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

“…For active removal of renal stones, we frequently choose extracorporeal shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), or percutaneous nephrolithotomy (PNL). SWL remains the first option for renal stones <20 mm, whereas PNL is usually performed for large renal stones of a maximum diameter ≥20 mm [ 1 ].…”