BERKELEY, CA (UroToday.com) - If retrospective studies follow patients over a long enough period of time they can contribute valuable information, posing important questions upon which further investigations are built. In this manuscript we had the opportunity to follow three separate nephrolithiasis treatment cohorts (percutaneous nephrolithotomy, shock wave lithotripsy, and conservative management) over a 19 year period. Our findings demonstrated that symptomatic stone recurrences are frequent in stone formers and the chosen treatment modality may be associated with subsequent stone recurrences.

Despite having the highest percentage of obese patients in the percutaneous nephrolithotomy cohort, these patients were less likely to develop recurrent stone disease compared to patients with similarly sized stones treated with shock wave lithotripsy. We also noted that those patients not immediately rendered stone free after percutaneous nephrolithotomy were more likely to experience symptomatic stone recurrences compared to those patients completely cleared of all stone fragments. We found no increased risk of developing adverse medical conditions in patients treated with percutaneous nephrolithotomy compared to those treated with shock wave lithotripsy or those who were allowed to spontaneously pass their stone. Limitations of the study have been cited; namely that it is retrospective and the treatment groups were not matched.

Furthermore, not all patients were followed in the same manner. Data was collected by chart review for the percutaneous nephrolithotomy and conservatively managed cohorts and the data for the shock wave lithotripsy cohort through chart review and mailed questionnaire.

Although this study lacks the statistical fortitude of a prospective trial, it is important nonetheless. The analysis provides further evidence for clearing patients of all stone debris to limit additional surgical intervention and it may also prompt urologists to choose treatment methods that are more likely to render patients stone free. Most importantly it encourages us to further explore the long-term consequences of surgical interventions for symptomatic stone disease.

Written by
Amy E. Krambeck, MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Long-Term Outcomes of Percutaneous Nephrolithotomy Compared to Shock Wave Lithotripsy and Conservative Management - Abstract

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