3-month Stone-free Rate Research Articles

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

Minimally invasive nephrolithotomy versus retrograde intrarenal surgery in surgical management of Lower calyceal stones: A systematic review with meta-analysis.

The efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) was assessed for lower calyceal (LC) stones. Our team conducted a systematic literature search up to December, 2022, using PUBMED, EMBASE and the Cochrane Library. The study was registered in PROSPERO, CRD 42021247197. Randomized controlled trials evaluating the efficacy and safety of MPCNL versus RIRS for LC stones were collected. Heterogeneity among the studies was assessed using the χ2 test based on the Q and I2 tests. Pooled effect sizes were calculated using a fixed model if I2 < 50%; otherwise, a random-effects model was chosen. The primary outcomes were the 3-month stone-free rate (3SFR) and total complications, while the secondary outcomes were the operating time, hospital stay, hemoglobin reduction, bleeding, postoperative fever and complications with the Clavien-Dindo system. A subgroup analysis of 10-20mm LC stones was also designed. A total of 7 peer-reviewed trials comprising 711 patients were identified. No statistical differences were observed in the heterogeneity results of the 3SFR or total complications (P>0.1, I2 < 50%). Compared with RIRS, MPCNL had an unfavorable safety profile, resulting in total complications (OR: 1.87 [95%CI: 1.05, 3.33]; P=0.03), hemoglobin reduction (OR: 0.81 [95%CI: 0.15, 1.47]; P=0.02) and complications with Grade I (OR: 5.52 [95%CI: 1.34, 22.83]; P=0.02) but an improved efficacy and 3SFR (OR: 2.43 [95%CI: 1.48, 3.97]; P=0.0004). As for the 10-20mm LC stones, compared with RIRS, MPCNL also had an unfavorable safety profile, resulting in total complications (OR: 2.47 [95%CI: 1.20, 5.07]; P=0.01), complications with Grade I (OR: 4.97 [95%CI: 0.99, 25.01]; P=0.05) and an increased hospital stay (OR: 2.46 [95%CI: 2.26, 2.66]; P=0.00001) but an improved efficacy and 3SFR (OR: 3.10 [95%CI: 1.61, 5.99]; P=0.0008). The efficacy effect of MPCNL and safety effect of RIRS were nearly equal for both stones sized < 20mm (NNT = 17, NNH = 20) and stones sized 10-20mm (NNT = 20, NNH = 13). No statistical difference was found between the MPCNL and RIRS groups for the rest of outcomes. Both MPCNL and RIRS are safe and effective management methods. Moreover, compared with RIRS, MPCNL had an unfavorable safety profile but improved efficacy for LC stones of ≤20mm or 10-20mm, and the differences were statistically significant. The relative profit of efficacy of MPCNL was similar to the relative profit of safety of RIRS.

Predictors of successful emergency shock wave lithotripsy for acute renal colic

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis.

Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children.Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old.Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15–108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202–8,265) mm3 in group I and 4,588 (2,039–5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42–111) months.Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.

Factors related to the success rate of pediatric extracorporeal shock wave lithotripsy (ESWL) in Cipto Mangunkusumo Hospital: an 8-year single-center experience

BackgroundESWL is still considered as the first favorable therapeutic option for urinary stone disease with acceptable effectivity. However, factors associated with favorable outcome have not been widely studied in pediatrics due to the small number of urinary stone prevalence. The aim of this study is to evaluate the factors associated with the success rate of pediatric ESWL in our center according to immediate stone-free rate and 3-month stone-free rates.MethodsThis is a retrospective cohort study of children less than 18 years who had ESWL for urolithiasis from January 2008 until August 2015. Patient’s characteristics including age, gender, BMI, stone location, stone length, stone burden, stone opacity, and number of ESWL sessions were gathered from the medical record. Nutritional status was determined according to the Centers for Disease Control and Prevention BMI curve. The outcome of this study was the factors related to the success rate in pediatric ESWL.ResultsExtracorporeal shock wave lithotripsy was done for 36 patients and 39 renal units (RUs) with mean age of 13.7 ± 4.3 years old, height of 1480 ± 16.0 cm, and BMI of 20.0 ± 3. Of 36 patients included, 39 renoureteral units (RUs) and 46 ESWL sessions were recorded. The mean overall treatment was 1.2 ± 0.5 sessions with mean stone length of 11.1 ± 6.3 mm and stone burden of 116.6 ± 130.3 mm2. Within 3 months of follow-up, we recorded that the overall 3-month success rate was 100%, while the overall 3-month stone-free rate was 66.7%. Stone length (p < 0.001 and p < 0.001), stone perpendicular length (p < 0.001 and p < 0.001), and stone burden (p < 0.001 and p = 0.001) were found to be significantly associated with immediate success and 3-month stone-free status, respectively.ConclusionsESWL is an effective and safe modality to treat pediatric urolithiasis cases. Stone length, stone perpendicular length, and stone burden were found to be associated with immediate success and 3-month stone-free status after pediatric ESWL treatment.

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial.

To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.

Single- versus Multiple-Tract Percutaneous Nephrolithotomy in the Surgical Management of Staghorn Stones or Complex Caliceal Calculi: A Systematic Review and Meta-analysis.

Objective To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal calculi or staghorn stones through a comprehensive literature review. Methods A comprehensive literature review of articles investigating the clinical efficacy and safety of single- versus multiple-tract percutaneous nephrolithotomy was performed. Relevant literature was obtained by systematically searching PubMed, EMBASE, and the Cochrane Library through May 2020. We followed the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes, including the stone-free rate (SFR), and secondary outcomes (peri- and postoperative complications and operative data) were evaluated using RevMan 5.3 statistical software. Results Ten studies involving 1844 patients with complex caliceal calculi or staghorn stones met the inclusion criteria. Single-tract percutaneous nephrolithotomy (STPCNL) had noninferior clinical efficacy with respect to the immediate SFR (odds ratio (OR) = 0.80, 95% confidence interval (CI) (0.46 to 1.38), p = 0.42) and 3-month SFR (OR = 1.22, 95% CI (0.38 to 3.92), p = 0.74) compared with multiple-tract percutaneous nephrolithotomy (MTPCNL). In addition, pooled analyses showed that STPCNL resulted in significantly lower hemoglobin decreases (MD = −0.46, 95% CI (-0.68 to -0.25), p < 0.0001), fewer blood transfusions (OR = 0.48, 95% CI (0.34 to 0.67), p < 0.0001), and fewer pulmonary complications (OR = 0.28, 95% CI (0.09 to 0.83), p = 0.02) than MTPCNL. However, the overall evidence was insufficient to suggest a statistically significant difference for other adverse events. Conclusion This meta-analysis indicated that STPCNL is an effective method for treating complex caliceal calculi or staghorn stones. Compared with MTPCNL, STPCNL not only yields similarly high SFRs but also is associated with many advantages, less blood loss, fewer blood transfusions, and fewer pulmonary complications without an increase in other complications. However, the findings of this study should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with a larger patient series.

Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: A prospective randomized study.

Context:The management of renal stones of high density (>1000 Hounsfield units) on non-contrast computed tomography (NCCT), and moderate sized (15-25 mm) is still debatable.Aims:The aim of this study was to compare the outcomes of percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) for the high-density and moderate-sized renal stones regarding the stone-free rate (SFR), morbidity, and patients' quality of life.Settings and Design:This is a prospective randomized study.Patients and Methods:Eighty consecutive patients with renal stones, excluding those with lower calyceal stones, were randomized to receive either PCNL or SWL (40 in each arm). Patients were followed up by abdominal ultrasound and plain X-ray (NCCT if indicated) till clearance of stone. Outcomes, complications, costs, and SF-8 Health Survey scoring were recorded for each group.Statistical Analysis:We used Stata software, version 9.2 (Intercooled STATA®; StataCorp LP College Station, Texas, USA). Comparison of the two groups was made with regard to patient and stone criteria and the procedure details. Continuous variables were compared using the Mann–Whitney U-test with values shown as the median and interquartile range. Categorical variables were compared using the Pearson's Chi-square/Fisher's exact test. Multivariate logistic regression analysis was used to identify variables independently associated with the stone clearance after two sessions of SWL. P < 0.05 was considered statistically significant.Results:The basic characteristics of both groups were comparable. After a single treatment session, the SFR was 80% and 27.5% for PCNL and SWL, respectively (P < 0.001). The overall 3-month SFR was 87.5% versus 90%, respectively (P = 0.723). The median number of the required maneuvers was 1 (range: 1–3) for PCNL versus 2 (range: 1–4) for SWL (P < 0.001). The complication rate was 10% and 7.5%, respectively (P = 0.692). The cost of SWL was significantly lower (P < 0.001). On multivariate analysis, a single stone was an independent predictor for stone clearance after two sessions of SWL (odds ratio: 7.26, 95% confidence interval: 1.13–46.62, P = 0.037).Conclusions:PCNL for the dense, and moderate-sized renal stone provides higher initial success and lower re-treatment rates compared with SWL with comparable outcome after 3 months of therapy. However, SWL is an alternative, especially for a single stone.

MP54-20 ACCURACY OF ULTRASONOGRAPHY FOR THE EVALUATION OF UROLITHIASIS IN PATIENTS UNDERGOING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY: COMPARISON WITH NON-CONTRAST COMPUTED TOMOGRAPHY

INTRODUCTION AND OBJECTIVES: percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (1025mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS: A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS: Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p 1⁄4 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p 1⁄4 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.1346.62, p1⁄40.037). CONCLUSIONS: For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone.

MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL Ahmad A Elderwy, Mohamed Gadelmoula, Ghaleb Althamthami, and Ahmad Abdulmoneim Ahmad A ElderwyAhmad A Elderwy More articles by this author , Mohamed GadelmoulaMohamed Gadelmoula More articles by this author , Ghaleb AlthamthamiGhaleb Althamthami More articles by this author , and Ahmad AbdulmoneimAhmad Abdulmoneim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (10- 25mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF-8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p = 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p = 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.13- 46.62, p=0.037). CONCLUSIONS For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e734 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmad A Elderwy More articles by this author Mohamed Gadelmoula More articles by this author Ghaleb Althamthami More articles by this author Ahmad Abdulmoneim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Single Center Experience Comparing Miniperc and Shockwave Lithotripsy for Treatment of Radiopaque 1-2 cm Lower Caliceal Renal Calculi in Children: A Prospective Randomized Study.

A prospective randomized study was performed comparing miniperc and shockwave lithotripsy (SWL) for treatment of radiopaque 1 to 2 cm lower caliceal renal calculi in children to evaluate safety and efficacy of these procedures. Pediatric patients (<15 years) with a single radiopaque lower caliceal renal stone 1 to 2 cm undergoing treatment between March 2012 and September 2013 in our department were randomized into two groups-group A, miniperc; group B, SWL. The two groups were compared statistically regarding patient demographic profile, 3-month stone-free rate (SFR), re-treatment rates, auxiliary procedures, and complications. There were 106 patients enrolled in each group. The mean age (10.3 years vs 10.7 years, P=0.57) and stone size (12.7 mm vs 12.9 mm, P=0.31) were similar between group A and B patients. The re-treatment rate and auxiliary procedure rate were significantly greater in group B compared with group A (41.5% vs 2.8% and 14.2% vs 5.6%, respectively; P<0.001). The overall 3-month SFR was 94.3% for group A vs 83% for group B (P=0.03). The complication rate (20.7% vs 3.7%; P=0.01) and hospital stay (3.7 days vs 7.1 hours; P=0.01) was significantly higher in group A compared with group B. Blood transfusion was given in 10.3% patients in group A vs none in group B (P=0.01). Miniperc is more efficacious than SWL for treatment of radiopaque lower caliceal renal calculi 1 to 2 cm in children in terms of higher SFR and lesser auxiliary and re-treatment rates. Miniperc, however, resulted in more complication, operative time, radiation exposure, and hospital stay.

A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones &lt;2 cm: A Single Center Experience

The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures. Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21). Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.

A Prospective, Randomized Comparison of Shock Wave Lithotripsy, Retrograde Intrarenal Surgery and Miniperc for Treatment of 1 to 2 cm Radiolucent Lower Calyceal Renal Calculi: A Single Center Experience

A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for the treatment of 1 to 2 cm radiolucent lower calyceal renal calculi was done to evaluate the safety and efficacy of these procedures. Patients with a single 1 to 2 cm radiolucent lower calyceal renal stone who underwent treatment between January 2012 and May 2013 were included in study. They were randomized to shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Patient demographic profiles, success and re-treatment rates, auxiliary procedures and complications were analyzed. A total of 45 patients were enrolled in each of the shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Three, 2 and 4 patients, respectively, were excluded from final analysis due to a matrix stone diagnosis. Mean procedure and fluoroscopy times were significantly greater in the miniperc group than in the other groups. Hospital stay (3.1 days vs 3.1 hours and 1.3 days, p = 0.01) and the blood transfusion rate (13.3% vs 0% and 0%, p = 0.03) were significantly higher for miniperc vs shock wave lithotripsy and retrograde intrarenal surgery, respectively. The re-treatment rate (63.4% vs 2.1% and 2.2%, p <0.001) and the auxiliary procedure rate (20.2% vs 8.8% and 6.6%, p = 0.02) were significantly greater for shock wave lithotripsy than for retrograde intrarenal surgery and miniperc, respectively. The 3-month stone-free rate of shock wave lithotripsy, retrograde intrarenal surgery and miniperc was 73.8% (31 of 42 patients), 86.1% (37 of 43) and 95.1% (39 of 41), respectively (p = 0.01). Miniperc and retrograde intrarenal surgery were more effective than shock wave lithotripsy to treat 1 to 2 cm radiolucent lower calyceal renal calculi in terms of a better stone-free rate, and lesser auxiliary and re-treatment rates. However, miniperc resulted in more complications, greater operative time and radiation exposure, and a longer hospital stay.

Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience

To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney stones. Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected retrospectively by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics, stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication rates between prone- and supine PCNL. One hundred seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole (single stone: 53.6%; multiple stones: 46.4%). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple lower pole stones were treated with supine PCNL (5.8 vs. 23.1%; p = 0.0001, and 25 vs. 81.5%; p = 0.0001, respectively, for prone- and supine PCNL). One-month SFR was 88.9%; an auxiliary procedure was needed in 6 patients; the 3-month SFR was 90.2%. There were 9 post-operative major complications (7.7%). No differences were observed in terms of 1- and 3-month SFRs (90.4 vs. 87.7%; p = 0.64; 92.3 vs. 89.2%; p = 0.4) and complication rates (7.6 vs. 7.7%; p = 0.83) when comparing prone- versus supine PCNL, respectively. The results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, regardless the position used. Supine PCNL was more frequently offered in case of patients at higher ASA score and in case of multiple lower pole stones.

Clinical reports of 20 625 cases of B ultrasound-guided ESWL for urinary stones

Objective To summarize the clinical experience of ESWL under B ultrasound guidance in treatment of urinary stones.Methods The clinical data of 20 625 patients who underwent B ultrasound-guided ESWL between August 1995 and July 2011 were retrospectively analyzed.Of the stones,8659cases were in the kidney,11 712 cases were in the ureter,and 254 cases were in the bladder.And 1965stones were radioparent.Results The stone fragmentation rates of the kidney,ureter and bladder stones were 96.27％ ( 8336/8659),97.56％ ( 1 1 426/1 1 712) and 99.21％ ( 252/254),respectively.The total stone fragmentation rate was 97.04％ (20 014/20 625 ).The 3-month stone-free rates of the kidney,ureter and bladder stones were 86.63％ (7501/8659),95.32％ ( 11 164/11 712) and 97.24％ (247/254),respectively.The total 3-month stone-free rate was 91.69％ (18 912/20 625).The stone fragmentation rate of radioparent stones was 97.91％ ( 1924/1965 ),and the 3-month stone-free rate was 94.40％ ( 1855/1965).Conclusion B ultrasound-guided ESWL is safe and effective in the treatment of urinary stones. Key words: Urinary calculi; Extracorporeal shockwave lithotripsy ; B ultrasound guidance

Treatment of renal stones in infants: comparing extracorporeal shock wave lithotripsy and mini-percutaneous nephrolithotomy

The objective of the study is to compare the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) and mini-percutaneous nephrolithotomy (MPCNL) in treating renal stones sizing 15-25 mm in infants <3 years. Forty-six infants with renal stones sizing 15-30 mm were treated by either ESWL (22 renal units in 22 infants) using Dornier compact delta lithotripter or MPCNL (25 renal units in 24 infants) using 14F-18F renal access under general anesthesia. The operation time, stone-free rate, re-treatment rate, and complications between the two groups were compared with the χ(2), Mann-Whitney U, and Student's t tests. No significant differences in mean age and stone size were observed between the two groups. The 1- and 3-month postoperative stone-free rates were 84 and 96% in MPCNL group and were 31.8 and 86.4% in ESWL group. The re-treatment and complication rates were significantly higher in ESWL group than in MPCNL group (50 vs. 12%, P = 0.004; 16.0 vs. 45.5%, P = 0.028). The stone recurrence rate was similar between the two groups. No significant changes of serum creatinine (Cr) level and glomerular filtration rate were observed in both groups. In conclusion, MPCNL is an effective and feasible alternative monotherapy for large renal stones (15-25 mm) in infants, with a higher stone-free rate and a lower complication rate when compared with ESWL.

Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre

ObjectiveTo present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. Patients and methodsA database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3months. ResultsMultiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P=0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P=0.001). ConclusionsPCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

A Prospective Randomized Comparison Between Early (&lt;48 Hours of Onset of Colicky Pain) Versus Delayed Shockwave Lithotripsy for Symptomatic Upper Ureteral Calculi: A Single Center Experience

The role of early/emergency shockwave lithotripsy (SWL) in symptomatic upper ureteral calculi has still not been established. We have performed a randomized comparison between early (<48 hours) vs delayed (>48 hours) SWL for symptomatic upper ureteral stones less than 1 cm to evaluate the feasibility, safety, and efficacy of early SWL in these patients. One hundred and sixty consecutive patients with a single radiopaque upper ureteral stone <1 cm, who presented with an episode of colicky pain and who were undergoing treatment between July 2008 and June 2009 in our department were included. The patients were hospitalized and randomized into two groups-group A: SWL was performed within 48 hours of onset of colicky pain (early SWL) using the electromagnetic lithotripter (Dornier Alpha Compact) along with analgesics and hydration therapy; group B: SWL was performed after 48 hours (delayed SWL) along with analgesics and hydration therapy. The statistical analysis was performed in two groups regarding the patient demographic profile, presence of hydronephrosis, time to stone clearance, success rates, number of sessions needed, auxiliary procedures, modified efficiency quotient (EQ), and complications. Eighty patients were enrolled in each group. The mean stone size was 7.3 mm in group A vs 7.5 mm in group B (P = 0.52). The stone fragmentation rate was 88.75% in group A vs 91.2% in group B (P = 0.35). The overall 3-month stone-free rate was 86.3% (69/80) for group A vs 76.2% (61/80) for group B (P = 0.34). The mean time taken for stone clearance was significantly less in group A than in group B (10.2 days vs 21.1 days; P = 0.01). The number of sessions needed in group A were significantly less than in group B (1.3 vs 2.7; P = 0.01). The auxiliary procedure rate was also significantly lesser in group A than group B (16.3% vs 32.5%; P = 0.001). The modified EQ (in %) was 67.2 in group A vs 59.4 in group B (P = 0.21). The steinstrasse formation and requirement for percutaneous nephrostomy (PCN) were significantly less in group A (P:0.02 and P:0.01 respectively). Early SWL (within 48 hours of onset of colicky pain) is feasible, safe, and highly efficacious in the management of symptomatic proximal ureteral stones <1 cm, resulting in a lesser requirement of number of SWL sessions, time taken for stone clearance, auxiliary procedure rate, and fewer complications in comparison with delayed SWL.

Extracorporeal Shock Wave Lithotripsy in Prepubertal Children: 22-Year Experience at a Single Institution With a Single Lithotriptor

The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency. We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need for tubing, the 3-month stone-free rate, the need for additional ESWL, and the effect of stone size and location, and cystinuria on the 3-month stone-free rate. Between 1986 and 2008, 119 males and 97 females with a mean age of 6.6 years who had urolithiasis underwent ESWL using the Dornier HM3 lithotriptor. We treated 157 children with renal calculi with an average +/- SD diameter of 14.9 +/- 8.9 mm, of whom 66 (42%) required a tube in the urinary system. The 3-month stone-free rate was 80% and 31 patients (19.7%) needed an additional procedure. Stone location did not affect the stone-free rate but stone size did. We treated 59 patients for ureteral stones with an average stone length of 9.5 +/- 4.8 mm, of whom 41 (69%) required tube insertion. The 3-month stone-free rate was 78% and 13 patients (22%) needed an additional procedure. The 3-month stone-free rate did not depend on stone location or size. The rate was 37.5% in patients with cystinuria and 82.5% in all others (p <0.0001). Six patients (2.8%) had complications. The 3-month stone-free rate after ESWL in prepubertal patients is 80% and 20% of patients require additional procedures. ESWL is most effective for kidney stones less than 11 mm. ESWL has inferior results for cystine stones compared to other calculi. Complications are rare.

FOURTH GENERATION LITHOTRIPTER: DO WE HAVE A NEW BENCHMARK FOR COMPARISON?

terms of clinical success, 3-month stone-free rate, re-treatment rate, auxiliary procedures and EQ, this is comparable to that reported by Nomikos et al. [1]. Overall, it should be recognized that comparing the results achieved with various lithotripsy units at various institutions is difficult, if not impossible, due to variability in patient selection, definition of success, follow-up methods, and the reported use and classification of auxiliary procedures. In this setting, claiming a new standard for the comparative assessment of new-generation lithotripters can be misleading, even if it is stimulating for the scientific debate on this intriguing issue.