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A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience

A better understanding on the treatment options for lower pole stones

  • Original Article
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Abstract

Purpose

To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm.

Materials and methods

Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed.

Results

The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C (p = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min (p = 0.082)], fluoroscopic time [175.6 vs. 31.8 min (p = 0.004)] and hospital stay [3.7 vs. 1.3 days (p = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% (p < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C (p < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively.

Conclusions

RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay.

ISRCTN 55546280.

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Abbreviations

LP:

Lower pole

RIRS:

Retrograde intrarenal surgery

SWL:

Shock wave lithotripsy

PCNL:

Percutaneous lithotripsy

SFR:

Stone-free rate

FURS:

Flexible ureteroscopy

KUB:

Kidney–ureter–bladder

US:

Ultrasound

SS:

Steinstrasse

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Acknowledgements

The authors thank Laura Viganò for her help in editing the manuscript.

Author information

Author notes

  1. G. Bozzini and P. Verze contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Humanitas Mater Domini, Via Gerenzano 2, 21053, Castellanza, Varese, Italy

    G. Bozzini & G. Taverna

  2. Department of Urology, University of Naples Federico II, Naples, Italy

    P. Verze & V. Mirone

  3. Department of Urology, Second University of Naples, Naples, Italy

    D. Arcaniolo & M. De Sio

  4. Universitätsklinik für Urologie, Graz, Austria

    O. Dal Piaz & K. Pummer

  5. Humanitas University, Milan, Italy

    N. M. Buffi, G. Guazzoni & M. Provenzano

  6. Department of Urology, Lomonosov Hospital, Moscow, Russia

    B. Osmolorskij

  7. Department of Urology, London Barts Hospital, London, UK

    F. Sanguedolce

  8. Department of Urology, Policlinico di Milano, Milan, Italy

    E. Montanari

  9. ASST San Paolo, Milan, Italy

    N. Macchione

  10. ESUT European Section for UroTechnology, Arnhem, Netherlands

    G. Bozzini & F. Sanguedolce

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  1. G. Bozzini
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Contributions

GB: Project Development, Data management, Manuscript writing. PV: Project Development, Data management, Manuscript writing. DA: Project Development, Data management, Manuscript writing. ODP: Data Collection. NMB: Manuscript editing. GG: Manuscript editing. MP: Data Collection. BO: Data Collection. FS: Data Collection. EM: Manuscript editing. NM: Data Collection. KP: Manuscript editing. VM: Manuscript editing. MDS: Manuscript editing and writing. GT: Manuscript editing.

Corresponding author

Correspondence to G. Bozzini.

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The authors state they have no conflicts of interest.

Human and animal rights

Clinical Research involving Human Participants but no Animals.

Informed consent

Informed consent form was signed by each participant. The study was registered at ISRCTN 55546280.

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Bozzini, G., Verze, P., Arcaniolo, D. et al. A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience. World J Urol 35, 1967–1975 (2017). https://doi.org/10.1007/s00345-017-2084-7

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  • DOI: https://doi.org/10.1007/s00345-017-2084-7

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