Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a...
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Transcript of Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a...
Title:
Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm
Single Renal Pelvis Stone
Authors: Mohammed Hassan, Ahmed R. EL-Nahas, Khaled Z.
Sheir, Nasr A. El-Tabey, Ahmed M. El-Assmy and Ahmed A. Shokeir
Affiliation:
Urology Department, Urology and Nephrology Center,
Mansoura University, Mansoura, Egypt
Aim of the studyAim of the study
To compare the efficacy, safety and cost of
extracorporeal shockwaves lithotripsy (SWL)
and percutaneous nephrolithotomy (PNL) in
treatment of a 20-30 mm single renal pelvis
stone.
Patients and MethodsPatients and Methods
Retrospective Study Between January 2006 and December 2012 Exclusion criteria:
– Patients aged <18 years, – Branched stone– Advanced hydronephrosis, – Solitary kidney, anatomical renal abnormality– Received treatment for this stone within the
past 6 months.
In PNL group: – Prone positionProne position– Fluoroscopic guided renal punctureFluoroscopic guided renal puncture– Dilatation with Alken’s metal dilator to 30 FDilatation with Alken’s metal dilator to 30 F– Disintegrated: ultrasonic or pneumaticDisintegrated: ultrasonic or pneumatic– A 22 F nephrostomy tube was placed and left A 22 F nephrostomy tube was placed and left
for 24-48 hours for 24-48 hours
Patients and MethodsPatients and Methods
In SWL group:
– Electromagnetic Dornier lithotripter S (Dornier Electromagnetic Dornier lithotripter S (Dornier MedTech GmbH, Germering, Germany) was MedTech GmbH, Germering, Germany) was used. used.
– Shockwaves were delivered at a rate of 80 Shockwaves were delivered at a rate of 80 shocks/minutes till a maximum of 3000 shocks/minutes till a maximum of 3000 shocks per session. shocks per session.
Patients and MethodsPatients and Methods
Evaluation
The stone free status was evaluated 3 months after PNL or last SWL session by NCCT.
Success included patients who became stone free or had insignificant residual (4 mm or less).
Comparison: The 2 groups were compared for:
Re-treatment rate, secondary procedures The costs of primary and secondary procedures
Patients and MethodsPatients and Methods
ResultsResults
SWL 167 Patients
PNL 170 Patients
P
Patients characters
Age (years) Mean ± SD 47.7 ± 11.7 50.9 ± 12.4 0.018
BMI Mean ± SD 31.6 ± 4.6 31.9 ± 7.4 0.589
Stone character
Side 0.449
RightLeft
77 (46%)90 (54%)
84 (49.4%)86 (50.6%)
Largest diameter (mm) 23.5 ± 2.7 25.1 ± 3 < 0.001
Stone surface area (mm2) 295 ± 100 383 ± 136 < 0.001
SSD (cm, mean ± SD) 9.9 ± 1.9 10.6 ± 2.5 0.011
Attenuation value (HU) 826 ± 353 740 ± 359 0.122
SWL 167 Patients
PNL 170 Patients
P
Efficacy N. (%) N. (%)
Success 115 (75%) 162 (95.3%) < 0.001
Re-treatment 126 (75.4%) 9 (5.3%) < 0.001
Secondary procedure
42 (25%) 8 (4.7%) < 0.001
ResultsResults
SWL 167 Patients
PNL 170
Patients
P
Safety N. (%) N. (%)
Complications(Clavien Class.)
overallG I
G IIG IIIa
11 (6.6)0 (0)
4 (2.4)7 (4.2)
22 (12.9)7 (4.1)6 (3.5)9 (5.3)
0.050
Total Cost ($US) < 0.001
Median (Range)
490(350-1820)
1120(1118-1750)
ResultsResults
ConclusionsConclusions
For treatment of a single renal pelvis stone
of 20-30 mm:
– PNL was more effective than SWL. PNL was more effective than SWL.
– SWL had lesser complications and SWL had lesser complications and
lower cost. lower cost.