Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20–30mm single renal pelvic stone (original) (raw)
Related papers
International Journal of Endorsing Health Science Research
Background: Despite its historical significance, ESWL has witnessed changes in its role, necessitating refined technical approaches and stringent patient selection criteria for optimal outcomes. This study aims to assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) for treating renal pelvis stones ranging from one to two centimeters in size.Methodology: A descriptive case series was conducted at the Department of Urology and Renal Transplantation, SIUT, Karachi. The study enrolled 81 patients aged 20 to 60, of both genders, with a single renal pelvis stone sized 1 2 cm. Patients with ureteral obstruction were excluded. Informed consent was obtained before performing extracorporeal shock wave lithotripsy (ESWL). Follow ups were carried out regularly, and final success was assessed one month post ESWL session.Results: The mean age of participants was 41.93 ± 9.67 years, with the majority (54.32%) falling within the 41 to 60 age range. Out of 81 patients, 49 (60.49%) we...
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Although shockwave lithotripsy is introduced 3 decades ago still it is the first line surgical management to meet huge burden of urinary stones worldwide, despite availability of other newer modalities of effective treatment. For developing countries like India, it is very helpful and promising to meet demand of huge burden of patients with less number of urologist. Our aim was to study the efficacy and outcome of this procedure in our institute and how it is influencing the guidelines. Materials and methods: A prospective study over a period of two years was conducted in the department of urology in VIMSAR, Burla with patients 15-60 years age having single solitary stone of below 2cm size in the kidney and below 1 cm size for upper ureteric stone. Efficacy and outcome were calculated as rate of stone clearance, percentage of complications. Statistical analysis was performed. Results: A statistically significant 85.3% of patients get cleared and labelled stone free. Whereas 14.7% of patients having incomplete clearance switched over to other modality of treatment. A 20.6% of patients reported transient pain and other complication treated with appropriate medication which gradually subsided in follow-up. Conclusion: ESWL is the first line of management for renal and upper ureteric calculus in properly selected patients as it is non-invasive, economical, efficacious with minimal complication and can be done as day care procedure.
International Urology and Nephrology, 2006
Objectives: To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Patients and methods: Between January 2000 and December 2003, 427 patients with single or multiple renal stones (<30 mm, largest diameter) underwent ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of followup. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments <4 mm. The success rate was correlated with the characteristics of the patients, conditions of the urinary tract and stone features. Results: At 3-month follow-up, the overall success rate was 333/427 (78%). Repeat treatment was needed in 226 patients (53.1%). Post-ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. Conclusions: The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.
European Urology Supplements, 2016
To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi. Patients and methods: We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stonefree patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan-Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Coxregression analysis. Results: For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.
Cureus
Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r 2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.
Pakistan Journal of Medical and Health Sciences
Objective: To find the frequency of patients of renal calculi with different stone densities and to evaluate the success rate of ESWL treatment in selected groups of patients i.e. low, medium and high stone density. Methodology: In this descriptive case series, at Department of Urology, Services Hospital, Lahore was conducted and enrolled a 100 cases with single, radiopaque renal stone of 1-2 cm (10 to 20 mm), between 15-80 years of either gender whereas those with calculus in nonfunctioning kidney (GFR less than 15 ml/min), calculus in Pyonephrotic kidney, presence of JJ stent and having previous surgery for stone on same side or radiolucent stones were excluded from this study. All sessions of ESWL were performed following departmental protocol. 3 weeks after the ESWL session, the outcome was evaluated by plain X-ray KUB and USG KUB. In this analysis, ESWL success was defined as either total stone clearance or the presence of clinically insignificant residual fragments (CIRFs) (4 ...
Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : časopis Društva za medicinsku informatiku BiH, 2014
Elimination of stone is determined by size and its localization. Stone from the ureter in 80% of cases can be eliminated spontaneously. If the stone by its characteristics is not spontaneously eliminated, taken are further steps and therapeutic protocols to solve this problem. The study was prospective, open and comparative. It was conducted at the Urology Clinic Clinical Center of Sarajevo University in the period from 2007 to 2013. The study included 404 patients with urinary tract lithiasis treated by ESWL. ESWL treatment is performed on the machine Siemens Model Lithostar Multiline, which has a combined ultrasonographic and fluoroscopic display, large energy density in order to obtain optimum focus (without damaging surrounding tissue) and minimal pain that on rare occasions requires for mild sedation-sedation. From a total of 404 patients included in the study there were 234 (57.92%) male and 170 (42.08%) female patients. The most common type of stone both in female and male pa...
Arab Journal of Urology, 2017
Objective: To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL). Patients and methods: Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of P1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m 2 were excluded from the study. The following data were reported: patients' demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR). Results: In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients' demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean