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A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent?
J Endourol. 2011 Mar; 25(3):481-5.JE

Abstract

BACKGROUND AND PURPOSE

Shockwave lithotripsy (SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10 mm in diameter, whereas stones that are larger than 20 mm are best managed by percutaneous nephrolithotomy (PCNL). The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy (URS), and PCNL outcomes for intermediate-sized upper tract calculi (100-300 mm(2)).

PATIENTS AND METHODS

Analysis was restricted to those patients who were treated for a renal calculus that measured between 100 and 300 mm(2) during a 4-year span. Demographic, stone, patient, treatment, and follow-up data were collected from a prospectively maintained database.

RESULTS

A total of 137 patients were referred with nonstaghorn calculi with an area between 100 and 300 mm(2). Fifty-three (38.7%) patients were treated with SWL, while 41 (29.9%) and 43 (31.4%) underwent ureteroscopy and PCNL, respectively. Mean stone area was higher in the PCNL group (P < 0.001), whereas stone density was higher for patients undergoing SWL (P = 0.002). Single treatment success rates were better for PCNL at 95.3%,vs 87.8% for ureteroscopy and 60.4% for SWL, P < 0.001. When allowing for two SWL treatments, the success rate improved to 79.2%, thus equalizing the success of the three treatment modalities (P = 0.66). Auxiliary treatments were more common after SWL (42.3%; P < 0.01).

CONCLUSIONS

For intermediate-sized upper-tract stones, when allowing for up to two SWL treatments, there was no significant difference between treatment modalities. Thus, SWL is a reasonably successful treatment alternative for patients who are not fit for a general anesthetic or who prefer SWL over competing treatments, provided they accept a potentially higher number of treatments.

Authors+Show Affiliations

Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

21351888

Citation

Wiesenthal, Joshua D., et al. "A Comparison of Treatment Modalities for Renal Calculi Between 100 and 300 Mm2: Are Shockwave Lithotripsy, Ureteroscopy, and Percutaneous Nephrolithotomy Equivalent?" Journal of Endourology, vol. 25, no. 3, 2011, pp. 481-5.
Wiesenthal JD, Ghiculete D, D'A Honey RJ, et al. A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? J Endourol. 2011;25(3):481-5.
Wiesenthal, J. D., Ghiculete, D., D'A Honey, R. J., & Pace, K. T. (2011). A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? Journal of Endourology, 25(3), 481-5. https://doi.org/10.1089/end.2010.0208
Wiesenthal JD, et al. A Comparison of Treatment Modalities for Renal Calculi Between 100 and 300 Mm2: Are Shockwave Lithotripsy, Ureteroscopy, and Percutaneous Nephrolithotomy Equivalent. J Endourol. 2011;25(3):481-5. PubMed PMID: 21351888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? AU - Wiesenthal,Joshua D, AU - Ghiculete,Daniela, AU - D'A Honey,R John, AU - Pace,Kenneth T, Y1 - 2011/02/25/ PY - 2011/3/1/entrez PY - 2011/3/1/pubmed PY - 2011/7/2/medline SP - 481 EP - 5 JF - Journal of endourology JO - J Endourol VL - 25 IS - 3 N2 - BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10 mm in diameter, whereas stones that are larger than 20 mm are best managed by percutaneous nephrolithotomy (PCNL). The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy (URS), and PCNL outcomes for intermediate-sized upper tract calculi (100-300 mm(2)). PATIENTS AND METHODS: Analysis was restricted to those patients who were treated for a renal calculus that measured between 100 and 300 mm(2) during a 4-year span. Demographic, stone, patient, treatment, and follow-up data were collected from a prospectively maintained database. RESULTS: A total of 137 patients were referred with nonstaghorn calculi with an area between 100 and 300 mm(2). Fifty-three (38.7%) patients were treated with SWL, while 41 (29.9%) and 43 (31.4%) underwent ureteroscopy and PCNL, respectively. Mean stone area was higher in the PCNL group (P < 0.001), whereas stone density was higher for patients undergoing SWL (P = 0.002). Single treatment success rates were better for PCNL at 95.3%,vs 87.8% for ureteroscopy and 60.4% for SWL, P < 0.001. When allowing for two SWL treatments, the success rate improved to 79.2%, thus equalizing the success of the three treatment modalities (P = 0.66). Auxiliary treatments were more common after SWL (42.3%; P < 0.01). CONCLUSIONS: For intermediate-sized upper-tract stones, when allowing for up to two SWL treatments, there was no significant difference between treatment modalities. Thus, SWL is a reasonably successful treatment alternative for patients who are not fit for a general anesthetic or who prefer SWL over competing treatments, provided they accept a potentially higher number of treatments. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/21351888/A_comparison_of_treatment_modalities_for_renal_calculi_between_100_and_300_mm2:_are_shockwave_lithotripsy_ureteroscopy_and_percutaneous_nephrolithotomy_equivalent L2 - https://www.liebertpub.com/doi/10.1089/end.2010.0208?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -