Main Article Content
Objective: The aim of the current study was to compare the outcome of minimal invasive treatment (RIRS, m-PCNL) with the ESWL, Micro-Percutaneous Nephrolithotomy (m-PCNL), and Retrograde intrarenal surgery (RIRS) in patients with renal calculi less than two centimeters in size.
Methods: Preoperative renal ureter-bladder (KUB) film and computed tomography (CT) used to imaging stone size and localization in all patients. Ninety consecutive patients were randomized equally to three groups. We evaluated age, gender, stone size, length of hospitalization, stone-free rates, X-ray duration that patients were exposed during the processes, general anesthesia time, Visual Analogue Scale values, Modified Clavien Complication Scale scores after RIRS, mPCNL, and ESWL on renal stones smaller than 2 cm.
Results: At the end of the first month, stone-free rate for the lower calyx stones was 33.3% (3 patients out of 10) in ESWL, 83.3% (10 patients out of 12) in RIRS, and 90.9% (10 patients out of 11) in m-PCNL. ESWL's success in the lower-calyx stones was found to be low. Our rates for the stones in renal pelvis, middle, and upper calyx were % 85.7 (18 patients out of 21) in ESWL, % 94.4 (17 patients out of 18) in RIRS and % 94.7 (18 patients out of 19) in m-PCNL. No difference was observed in the duration of hospitalization among patients who underwent RIRS and m-PCNL. The VAS scores in ESWL group were higher than other groups. There were no significant differences for fluoroscopy time between the groups. Decrease in hemoglobin values before and after the procedure were found to be significant in m-PCNL group (p<0.05).
Conclusions: We compared three minimal invasive treatments for less than 2 cm renal stones; m-PCNL and RIRS methods were found to be more effective than ESWL, especially aspects of the stone free rates.
2. Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane database of systematic reviews. 2014 ;11.
3. Knoll T, Jessen J. P, Honeck P, Wendt-Nordahl G. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World journal of urology. 2011; 29: 755-759.
4. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. The Journal of urology. 2013; 189: 580-584.
5. Jackman S. V, Docimo S. G, Cadeddu J. A, Bishoff J. T, Kavoussi L. R, Jarrett T. W. The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World journal of urology. 1998; 16: 371-374.
6. Monga M, Oglovie S. Minipercutaneous nephrolithotomy. Journal of endourology. 2000; 14: 419-421.
7. El‐Nahas A. R, Ibrahim H. M, Youssef R. F, Sheir K. Z. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU international. 2012; 110: 898-902.
8. Sabnis R. B, Jagtap J, Mishra S, Desai M. Treating renal calculi 1–2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU international. 2012; 110: E346-E349.
9. Yoon C. Y, Kim D. S, Lee J. G. Stone free rate of SWL in renal calyceal stone according to its location. Korean Journal of Urology. 1999; 40: 138-142.
10. Singh B. P, Prakash J, Sankhwar S. N, Dhakad U, Sankhwar P. L, Goel A, Kumar M. Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes. Urology. 2014; 83: 1016-1022.
11. Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, Oztuna D. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World journal of urology. 2013; 31: 1581-1586.
12. Kruck S, Anastasiadis A. G, Herrmann T. R, Walcher U, Abdelhafez M. F, Nicklas A. P, Nagele U. Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World journal of urology. 2013; 31: 1555-1561.
13. Sabnis R. B, Ganesamoni R, Doshi A, Ganpule A. P, Jagtap J, Desai M. R. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU international. 2013; 112: 355-361.
14. Kirac M, Bozkurt Ö. F, Tunc L, Guneri C, Unsal A, Biri H. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm. Urolithiasis. 2013; 41: 241-246.
15. Hatipoglu N. K, Tepeler A, Buldu I, Atis G, Bodakci M. N, Sancaktutar A. A, Gurbuz C. Initial experience of micro-percutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units. Urolithiasis. 2014; 42: 159-164.