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A prospective, randomized trial of management for asymptomatic lower pole calculi.
J Urol. 2010 Apr; 183(4):1424-8.JU

Abstract

PURPOSE

We determined the natural course and compared the deleterious effects in kidneys of shock wave lithotripsy, percutaneous nephrolithotomy and observation for asymptomatic lower caliceal stones.

MATERIALS AND METHODS

Between April 2007 and August 2008 patients with asymptomatic lower caliceal calculi were enrolled in the study. To assess stone status noncontrast abdominal helical computerized tomography was done 3 and 12 months after intervention. All patients were evaluated by dimercapto-succinic acid renal scintigraphy 6 weeks and 12 months after intervention.

RESULTS

A total of 94 patients were prospectively randomized to percutaneous nephrolithotomy (31), shock wave lithotripsy (31) and observation (32). Mean +/- SD followup was 19.3 +/- 5 months (range 12 to 29). In the percutaneous nephrolithotomy group all patients were stone-free at month 12. Scintigraphy revealed a scar in 1 patient (3.2%) on month 3 followup imaging. In the shock wave lithotripsy group the stone-free rate was 54.8%. Scintigraphy revealed scarring in 5 patients (16.1%). In the observation group 7 patients (18.7%) required intervention during followup. Median time to intervention was 22.5 +/- 3.7 months (range 18 to 26). One patient (3.1%) had spontaneous stone passage. Scintigraphy did not reveal scarring in any patient.

CONCLUSIONS

Stone related events were noted in more than 20% of patients with asymptomatic lower caliceal stones observed expectantly. To manage lower caliceal stones percutaneous nephrolithotomy has a significantly higher stone-free rate with less renal scarring than shock wave lithotripsy. Thus, patients with asymptomatic lower caliceal stones must be informed in detail about all management options, especially focusing on percutaneous nephrolithotomy with its outstanding outcome.

Authors+Show Affiliations

Department of Urology, Haseki Teaching and Research Hospital and Department of Nuclear Medicine, Taksim Teaching and Research Hospital (EA), Istanbul, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20172565

Citation

Yuruk, Emrah, et al. "A Prospective, Randomized Trial of Management for Asymptomatic Lower Pole Calculi." The Journal of Urology, vol. 183, no. 4, 2010, pp. 1424-8.
Yuruk E, Binbay M, Sari E, et al. A prospective, randomized trial of management for asymptomatic lower pole calculi. J Urol. 2010;183(4):1424-8.
Yuruk, E., Binbay, M., Sari, E., Akman, T., Altinyay, E., Baykal, M., Muslumanoglu, A. Y., & Tefekli, A. (2010). A prospective, randomized trial of management for asymptomatic lower pole calculi. The Journal of Urology, 183(4), 1424-8. https://doi.org/10.1016/j.juro.2009.12.022
Yuruk E, et al. A Prospective, Randomized Trial of Management for Asymptomatic Lower Pole Calculi. J Urol. 2010;183(4):1424-8. PubMed PMID: 20172565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective, randomized trial of management for asymptomatic lower pole calculi. AU - Yuruk,Emrah, AU - Binbay,Murat, AU - Sari,Erhan, AU - Akman,Tolga, AU - Altinyay,Erkan, AU - Baykal,Murat, AU - Muslumanoglu,Ahmet Y, AU - Tefekli,Ahmet, Y1 - 2010/02/20/ PY - 2009/07/26/received PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/4/30/medline SP - 1424 EP - 8 JF - The Journal of urology JO - J. Urol. VL - 183 IS - 4 N2 - PURPOSE: We determined the natural course and compared the deleterious effects in kidneys of shock wave lithotripsy, percutaneous nephrolithotomy and observation for asymptomatic lower caliceal stones. MATERIALS AND METHODS: Between April 2007 and August 2008 patients with asymptomatic lower caliceal calculi were enrolled in the study. To assess stone status noncontrast abdominal helical computerized tomography was done 3 and 12 months after intervention. All patients were evaluated by dimercapto-succinic acid renal scintigraphy 6 weeks and 12 months after intervention. RESULTS: A total of 94 patients were prospectively randomized to percutaneous nephrolithotomy (31), shock wave lithotripsy (31) and observation (32). Mean +/- SD followup was 19.3 +/- 5 months (range 12 to 29). In the percutaneous nephrolithotomy group all patients were stone-free at month 12. Scintigraphy revealed a scar in 1 patient (3.2%) on month 3 followup imaging. In the shock wave lithotripsy group the stone-free rate was 54.8%. Scintigraphy revealed scarring in 5 patients (16.1%). In the observation group 7 patients (18.7%) required intervention during followup. Median time to intervention was 22.5 +/- 3.7 months (range 18 to 26). One patient (3.1%) had spontaneous stone passage. Scintigraphy did not reveal scarring in any patient. CONCLUSIONS: Stone related events were noted in more than 20% of patients with asymptomatic lower caliceal stones observed expectantly. To manage lower caliceal stones percutaneous nephrolithotomy has a significantly higher stone-free rate with less renal scarring than shock wave lithotripsy. Thus, patients with asymptomatic lower caliceal stones must be informed in detail about all management options, especially focusing on percutaneous nephrolithotomy with its outstanding outcome. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/20172565/A_prospective_randomized_trial_of_management_for_asymptomatic_lower_pole_calculi_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2009.12.022?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -