Percutaneous Nephrolithotomy Versus Non-Stented Extracorporeal Shock Wave Lithotripsy for Medium Sized Kidney Stones

Background: nephrolithiasis is a common complex disease. It is the third most common disaster of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. About 50 % of recurrent stone formers have just one life time recurrence. At present, the great expansion in minimally invasive techniques has led to the decrease in open stone surgery (OSS). Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves (SWs). Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PNL) are considered.
Aim of the work: this study aimed to evaluate the effectiveness of ESWL VS PNL in management of non-lower polar medium sized stone (1-2 cm) as regards to stone size, location and number.
Patients and Methods: this is a prospective randomized comparative clinical study that was conducted in Ain Shams Urology Department and Agouza Hospital Urology Department from December 2016 till September 2017.Sixty patients were enrolled; of which 30 patients underwent PNL and other 30 patients underwent Non-stented ESWL complaining of non-lower polar medium sized calyceal stones (1-2 cm). All patients were categorized into two subgroups; group A for ESWL and group B for PNL. Patients with lower calyceal stones, stone burden more than 2 cm, recurrent kidney stones, renal impairment, pregnant women and children were excluded from this study. Our study included 45 males (75%) and 15 females (25%) with a mean ± SD age 43.78±12.68 years (range 25 to 65). The patients’ criteria (age, sex, body mass index) and the stone characteristics (side, stone size, attenuation value and skin- to-stone distance) were compared between both groups. The SFR rate, the need for secondary procedures were calculated and compared.
Results: 30 patients underwent PNL and the other 30 patients underwent Non-Stented ESWL. Twenty nine patients (96.6%) who underwent PNL rendered SFR detected by Non-enhanced Helical CT (Less than 4 mm) after one month; two cases 2 mm and 3 mm CIRF and only one case with 4 mm residual whereas only 5 patients (16.7%) in the ESWL group with high significance (P < 0.001) and all patients in PNL group were completed stone clearance without auxiliary procedure (p< 0.001).
Conclusion: PNL is the modality of choice in medium sized (1-2cm) lower calyceal renal stone. PNL was more effective than ESWL for treating medium sized (1-2 cm) non lower polar renal stone, it has advantages of higher initial SFR with short time of treatment and lower auxiliary procedures (lower retreatment rate).However, ESWL was associated with fewer complications.