Comparison of SWL and RIRS in Lower Calyceal Stones

Abstract

Background: The efficacy of extracorporeal shock wave lithotripsy(SWL) in kidney stones in the lower calices was compared using retrograde intrarenal surgery(RIRS). Methodology And Materials: Between January 2008 and May 2011, 64 patients (40 male and 24 female) undergoing SWL and 60 patients (38 male 22 female) undergoing flexible URS were analyzed retrospectively, and success rates were compared. Using the Storz Medical Modulith SLK, patients underwent the SWL process prior to the induction of anesthesia. On the other hand, the 8 f Storz flex X2 flexible URS was used for URS after general anesthesia and RIRS. During the RIRS process, stones were crushed using the 0.2 mm diameter holmium: YAG laser probe, and stone fragments larger than 2 mm were extracted. In some cases, double J or ureteral catheters were placed in the ureter. Results: In the 64 patients undergoing SWL with lower caliceal stones, the following ranges were noted: stone diameter: 6-35 mm (mean 15.9 mm), age: 16-72 years (mean , sessions required: 1-4 sessions (mean: 1.6), the number of shots: 1000-7650 (mean: 4124.6), fire intensity: 25-75 (mean: 60). Ten percent of patients required analgesia, and the success rate of the procedure was 87.5%. Hematuria occurred in 65% of patients as a minor complication and in 2%,streinstrasse occurred as a major complication. Inpatients undergoing RIRS, the following ranges were noted: stones size: 7-30 mm in diameter (average 15.2 mm), age: 21-60 years (mean 39.75),duration of operation: 30-85 minutes(mean: 48.8 minutes), respectively. An access sheath was used in all 32 patients. Balloon dilation was performed in 8 patients with distal ureteral stenosis, and a double J catheter was placed in 2 patients because of stenosis in the upper ureter and four weeks later, the stones were treated with fURS. Patients were discharged on an average of 1.2 days (1-3 days). A ureteral laceration was noted in 30% of patients while 75% of patients had hematuria. Partial ureteral avulsion occurred in one patient with an overall success rate of 96.4%. Conclusions: During the treatment of lower caliceal stones, the success and complication rate of RIRS is higher than SWL.