Title:

Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 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 studyAim of the study

To compare the efficacy, safety and cost of

extracorporeal shockwaves lithotripsy (SWL)

and percutaneous nephrolithotomy (PNL) in

treatment of a 20-30 mm single renal pelvis

stone.

Patients and MethodsPatients 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 positionProne position– Fluoroscopic guided renal punctureFluoroscopic guided renal puncture– Dilatation with Alken’s metal dilator to 30 FDilatation with Alken’s metal dilator to 30 F– Disintegrated: ultrasonic or pneumaticDisintegrated: ultrasonic or pneumatic– A 22 F nephrostomy tube was placed and left A 22 F nephrostomy tube was placed and left

for 24-48 hours for 24-48 hours

Patients and MethodsPatients and Methods

In SWL group:

– Electromagnetic Dornier lithotripter S (Dornier Electromagnetic Dornier lithotripter S (Dornier MedTech GmbH, Germering, Germany) was MedTech GmbH, Germering, Germany) was used. used.

– Shockwaves were delivered at a rate of 80 Shockwaves were delivered at a rate of 80 shocks/minutes till a maximum of 3000 shocks/minutes till a maximum of 3000 shocks per session. shocks per session.

Patients and MethodsPatients 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 MethodsPatients and Methods

ResultsResults

SWL 167 Patients

PNL 170 Patients

P

Patients characters

Age (years) Mean ± SD 47.7 ± 11.7 50.9 ± 12.4 0.018

BMI Mean ± SD 31.6 ± 4.6 31.9 ± 7.4 0.589

Stone character

Side 0.449

RightLeft

77 (46%)90 (54%)

84 (49.4%)86 (50.6%)

Largest diameter (mm) 23.5 ± 2.7 25.1 ± 3 < 0.001

Stone surface area (mm2) 295 ± 100 383 ± 136 < 0.001

SSD (cm, mean ± SD) 9.9 ± 1.9 10.6 ± 2.5 0.011

Attenuation value (HU) 826 ± 353 740 ± 359 0.122

SWL 167 Patients

PNL 170 Patients

P

Efficacy N. (%) N. (%)

Success 115 (75%) 162 (95.3%) < 0.001

Re-treatment 126 (75.4%) 9 (5.3%) < 0.001

Secondary procedure

42 (25%) 8 (4.7%) < 0.001

ResultsResults

SWL 167 Patients

PNL 170

Patients

P

Safety N. (%) N. (%)

Complications(Clavien Class.)

overallG I

G IIG IIIa

11 (6.6)0 (0)

4 (2.4)7 (4.2)

22 (12.9)7 (4.1)6 (3.5)9 (5.3)

0.050

Total Cost ($US) < 0.001

Median (Range)

490(350-1820)

1120(1118-1750)

ResultsResults

ConclusionsConclusions

For treatment of a single renal pelvis stone

of 20-30 mm:

– PNL was more effective than SWL. PNL was more effective than SWL.

– SWL had lesser complications and SWL had lesser complications and

lower cost. lower cost.