Abstract
To compare the outcomes of flexible ureterorenoscopy (F-URS) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of upper or mid calyx kidney stones of 10 to 20 mm.A total of 174 patients with radioopaque solitary upper or mid calyx stones who underwent ESWL or F-URS with holmium:YAG laser were enrolled in this study. Each group treated with ESWL and F-URS for upper or mid calyx kidney stones were retrospectively compared in terms of retreatment and stone free rates, and complications.87% (n = 94) of patients who underwent ESWL therapy was stone free at the end of 3rd month. This rate was 92% (n = 61) for patients of F-URS group (p = 0.270 p > 0.05). Retreatment was required in 12.9% of patients (n = 14) who underwent ESWL and these patients were referred to F-URS procedure after 3rd month radiologic investigations. The retreatment rate of cases who were operated with F-URS was 7.5% (n = 5) (p = 0.270 p > 0.05). Ureteral perforation (Clavien grade 3B) was occured in 3 patients (4.5%) who underwent F-URS. Fever (Clavien grade 1) was noted in 7 and 5 patients from ESWL and F-URS group, respectively (6.4% vs 7.5%) (p = 0.78 p > 0.05).F-URS and ESWL have similar outcomes for the treatment of upper or mid calyx renal stones of 10–20 mm. ESWL has the superiority of minimal invasiveness and avoiding of general anethesia. F-URS should be kept as the second teratment alternative for patients with upper or mid caliceal stones of 10–20 mm and reserved for cases with failure in ESWL.
Highlights
The European Association of Urology (EAU), updates and publishes guidelines for urolithiasis and treatment algorithms every year
Retreatment was required in 12.9% of patients (n = 14) who underwent extracorporeal shock wave lithotripsy (ESWL) and these patients were referred to flexible ureterorenoscopy (F-URS) procedure after 3rd month radiologic investigations
The management of upper urinary tract stones is a complex issue and may vary according to the stone size, location, factors related to the patient and armamentarium of the department
Summary
The European Association of Urology (EAU), updates and publishes guidelines for urolithiasis and treatment algorithms every year. EAU 2014 guidelines state that stones between 10–20 mm in every locations should be treated with extracorporeal shock wave lithotripsy (ESWL) or endourologic interventions (Türk et al 2014). With the miniaturization and advancements in the designs of ureterorenoscopes, stone disintegration systems and endourologic techniques, most of the kidney stones and large proximal ureteral stones can be managed by flexible ureterorenoscopy (F-URS) nowadays (Bas et al 2013; Ching-Fang et al 2004). We aimed to compare the outcomes of F-URS with ESWL for the treatment of radioopaque solitary upper or mid calyx kidney stones of 10 to 20 mm
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