Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes.

Abstract

OBJECTIVE:

To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion.

METHODS:

Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared.

RESULTS:

Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL.

CONCLUSION:

For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.

• Authors: Bhupendra Pal Singh, Jai Prakash, Satya Narayan Sankhwar, Urmila Dhakad, Pushp Lata Sankhwar, Apul Goel, Manoj Kumar
• Journal: Urology (Urology) Vol. 83 Issue 5 Pg. 1016-22 (May 2014) ISSN: 1527-9995 [Electronic] United States
• PMID: 24560970 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Adult
• Female
• Humans
• Kidney Calculi (pathology, surgery, therapy)
• Kidney Calices
• Lithotripsy
• Male
• Nephrectomy (methods)
• Prospective Studies
• Treatment Outcome