1828 EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY VERSUS RETROGRADE INTRA RENAL SURGERY FOR 1-2 CM LOWER CALYCEAL CALCULI: A PROSPECTIVE CASE CONTROL STUDY

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131828 EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY VERSUS RETROGRADE INTRA RENAL SURGERY FOR 1-2 CM LOWER CALYCEAL CALCULI: A PROSPECTIVE CASE CONTROL STUDY Satya Narayan Sankhwar, Bhupendra Pal Singh, Jai Prakash, and Apul Goel Satya Narayan SankhwarSatya Narayan Sankhwar Lucknow, India More articles by this author , Bhupendra Pal SinghBhupendra Pal Singh Lucknow, India More articles by this author , Jai PrakashJai Prakash Lucknow, India More articles by this author , and Apul GoelApul Goel Lucknow, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2191AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Extra corporeal shock wave lithotripsy (ESWL) and Retrograde intra renal surgery (RIRS) are recommended options for the management of 1-2 cm inferior calyceal(IC) calculi. In this study we compared the outcomes of both modalities in this group of patients. METHODS From June 2011 to May 2012, 20 symptomatic adults (20-50 years) who had isolated IC stone between 10-20 mm were underwent RIRS. Outcomes of these patients were compared with 20 control patients from same age group who underwent ESWL for same size IC calculi during the study period. Patients with distal obstruction, calyceal diverticulum, pregnancy, active urinary tract infection, radiolucent stones, and serum creatinine > 3 mg /dl were excluded. ESWL were done by Dornier compact alpha lithotripter (Dornier MedTech System GmbH, 2500-4500 shocks per session) under intra venous sedation. RIRS were done by 7.5 Fr flexible ureterorenoscope with holmium:YAG laser (Lumenis/Versa Pulse Power Suite) lithotripsy under combined spinal and epidural anesthesia. The parameter compared were stone free rate (SFR) on X-Ray KUB at 3 weeks, mean operative time, hospital stay, complications and patient reported outcomes ie.voiding symptoms, time to return normal activity and satisfaction rate using self made non validated questionnaire. RESULTS Baseline parameters (age, sex, body mass index, side treated) were comparable in groups. Mean stone size was 14.05 ± 2.56 cm in RIRS and 14.45 ± 3.28 cm in ESWL. SFRs after the first, second, and third sessions of ESWL were 30, 45, and 50 %, respectively and 85 % after one session of RIRS (p=0.04).The mean procedure time (80.7±19.03 versus 40.25 ± 7.34 min.P= <0.0001) and hospital stay (36 ± 10.3 versus 6.2 ± 4.3 hrs, P= <0.0001) were significantly higher in RIRS than ESWL for single session. The overall complications were comparable (RIRS 35%, ESWL 30%). The satisfaction score (2.9±1.33 versus 1.9±1.16, P=0.0159) was significantly higher in RIRS than ESWL. Average time to return to normal activity (8.4±2.4 versus 2.4±1.3 days P= <.0001) was significantly higher in RIRS than ESWL after single session. Voiding symptoms score (RIRS 2.6±0.88, ESWL 2.45±0.82, P= 0.582) was comparable in both groups. CONCLUSIONS For moderate size (1-2cm) lower calyceal calculi, RIRS is superior to ESWL in term of SFR and patient satisfaction. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e750-e751 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Satya Narayan Sankhwar Lucknow, India More articles by this author Bhupendra Pal Singh Lucknow, India More articles by this author Jai Prakash Lucknow, India More articles by this author Apul Goel Lucknow, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...