Bailie et al. assessed outcomes on 31 patients each of which were randomized to one of the three treatment modalities. Treatments were performed as necessary until adequate stone-free status was achieved, which was assessed through post-treatment CT scan. Stone free rates (SFR) were 60%, 55%, and 80% for SWL, URS, and PCNL, respectively (p = .33). Overall, PCNL treatment resulted in fewer procedures (median = 1) than either SWL or URS (median = 2 for both) (p = .015), with a comparable length of hospital stay (LOS). Complication rate and severity was much higher with SWL (50%) than with either URS (9%) or PCNL (20%) (p = .019).
The presenter for this session was not able to address differences in stone composition, which may influence the appropriateness of these techniques in certain patients. However, this study presents compelling evidence that SWL is an inadequate method for treating large stone disease due to its higher complication rates and relatively low stone-free rate. This adds to the growing body of literature discouraging the use of SWL for large stone burden. PCNL, on the other hand, may be the most appropriate treatment modality given it comparable LOS, higher SFR, and fewer incidences of follow up procedures.
Presented by: John Bailie, Monash Health, Melbourne
Co-Authors: Shekib Shahbaz, Ivor Berman, Matthew Hong, Philip McCahy
Written by: Max Towe, medical writer for UroToday.com at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France