Comparison between retrograde intrarenal surgery and extracorporeal shock wave lithotripsy in the treatment of lower pole kidney stones up to 15 mm. Prospective, randomized study

Abstract

IntroductionExtracorporeal Shock Wave Lithotripsy (ESWL) is currently the recommended treatment for intra-renal calculi smaller than 2cm. However the low Stone Free Rate (SFR) in lower pole calculi gives rise to new techniques, such us retrograde intrarenal surgery (RIRS), for improve the surgery outcomes. ObjectiveTo compare the efficacy of a treatment with ESWL with RIRS, in terms of SFR after surgery, in patients with kidney stones up to 15mm in the lower pole. Materials and methodsA prospective study was carried out in order to assess the results of ESWL and RIRS in patients with lower pole stones less than 15mm. Among a total of 55 patients, 31 were underwent to ESWL (Group 1) and the remaining 24 to RIRS (Group 2). Clinical data recorded, including general characteristics of each patient, were: calculi size, side, operative time, complications according to Clavien scale, SFR and the presence of residual fragments at 2 months post-treatment assessed by a CT scan. STATA 11 was used to perform the statistical analysis. ResultsThere were no differences for general descriptors among groups with the exception of a significantly longer operative time for RIRS. The rates of SFR and residual fragments lesser than 3mm were lower in the RIRS group than in ESWL ones. RIRS also showed a lower rate of clinically significant fragments (0% versus 42.3%. p<0.05). In the subgroup of patients with stones between 10 and 15mm RIRS showed higher SFR (75% versus 41.2%) and a lower rate of stones>3mm (0% versus 58.8%), being statistically significant (p<0.05). Clavien III or higher complications were not reported in any of the groups. ConclusionsIn the treatment of lower pole stone RIRS has the same results than ESWL in terms of SFR. Regarding absence of a clinically significant residual fragment, RIRS was superior to ESWL. A bigger sample size is required in order to confirm this result.