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Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones

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Abstract

Objectives

To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10–20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications.

Patients and methods

A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group.

Results

Success rates were 66.5, 91.4, and 87 % for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7 %, respectively; p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9 %, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively).

Conclusions

For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.

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Conflict of interest

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Authors and Affiliations

  1. Ankara, Turkey

    Berkan Resorlu, Ali Unsal, Tevfik Ziypak, Akif Diri, Gokhan Atis, Selcuk Guven, Ahmet Ali Sancaktutar, Abdulkadir Tepeler, Omer Faruk Bozkurt & Derya Oztuna

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  1. Berkan Resorlu
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  2. Ali Unsal
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  3. Tevfik Ziypak
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  6. Selcuk Guven
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  7. Ahmet Ali Sancaktutar
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  8. Abdulkadir Tepeler
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  9. Omer Faruk Bozkurt
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  10. Derya Oztuna
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Correspondence to Berkan Resorlu.

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Resorlu, B., Unsal, A., Ziypak, T. et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31, 1581–1586 (2013). https://doi.org/10.1007/s00345-012-0991-1

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  • DOI: https://doi.org/10.1007/s00345-012-0991-1

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