Percutaneous nephrolithotomy for 1-2 cm lower-pole renal calculi

Comparative Study of Lithotripsy and PCNL for 11-15 mm Lower Caliceal Calculi In Community Health Hospital

BACKGROUND AND PURPOSE

Percutaneous Nephrolithotomy (PCNL) is not a popular procedure in smaller sized calculi due to its invasive nature, complications and need for anesthesia. Small sized lower caliceal calculi are generally treated by ESWL but have significantly less clearance rate in spite of several sittings. Here we want to study the efficacy and safe of both procedures in 11 to 15 mm lower caliceal calculi.

MATERIALS AND METHODS

We present comparative study of lithotripsy and PCNL in 11-15 mm lower caliceal calculi in our hospital. Total 156 patients were studied 78 underwent lithotripsy and 78 underwent PCNL. We compared results in the form of clearance rate, the number of settings needed, hospital stay, need for anesthesia, blood transfusion rate, chest complication, the incidence of sepsis, the need for another procedure, need for stenting in either group.

RESULTS

We found a 67.95% clearance rate in SWL group and 97.43% clearance rate in PCNL group. Hospital stay was minimum in SWL group and was 46 hours in PCNL group. The procedure time was 42 minutes in PCNL and it was 114 mins in SWL (considering all settings). The rest of the complications like chest complication, sepsis and bleeding were negligible due to the small size of calculi.

CONCLUSION

In a small sized LPC calculi, PCNL is gaining increased popularity due to lower complication and high safety and complete clearance rate. It is wide accepted by society as the patient is totally stone free at the end of the procedure. SWL is less invasive but less effective and has given significant discomfort to patients.

Management of 1-2 cm renal stones

INTRODUCTION

The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue. We searched the literature to present a comprehensive review on this group.

MATERIAL AND METHODS

Pubmed search of literature was done using the appropriate key words. We separately discussed the literature in lower polar and non lower polar stone groups.

RESULTS

For non lower polar renal stones of 1-2 cm, SWL is preferred approach, while for the lower polar stones; literature favors the use of PCNL. Retrograde intrarenal surgery (RIRS) is emerging as a promising technique for these calculi.

CONCLUSIONS

Treatment of renal stone disease depends on stone and patient related, as well as on renal anatomical factors. Treatment should be individualized according to site of stone and available expertise.

The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size

INTRODUCTION

Recently, few studies were reported about the treatment of large, solitary, renal calculi between shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL). We assess the feasibility of SWL for managing solitary, lower calyceal stones over 1 cm by comparing the results of lower pole calculi treatment between patients that underwent SWL or PNL.

METHODS

We retrospectively reviewed clinical data for patients who had undergone PNL or SWL due to lower calyceal stones over 1 cm. Group 1 consisted of patients who underwent SWL to treat lower pole renal calculi from 2010 to 2011. Group 2 included patients who underwent PNL to manage lower pole renal calculi from 2008 to 2009. We compared patient age, gender, stone size, comorbidities, postoperative complications, additional interventions and anatomical parameters between the two groups.

RESULTS

A total of 55 patients were enrolled in this study. The mean ages (±SD) of groups 1 (n = 33) and 2 (n = 22) were 55.1 (±13.0) and 50.0 (±10.6) years (p = 0.133) and mean stone sizes were 1.6 (±0.7) and 1.9 (±0.8) cm (p = 0.135), respectively. There were no significant differences in gender distribution, comorbidities or stone laterality between the two groups. No significant differences in various parameters were observed between patients with stones 1 to 2 cm and ones with stones 2 cm or larger.

CONCLUSIONS

Our results demonstrated that SWL is a safe, feasible treatment for solitary, lower calyceal stones over 1 cm.