Despite technology incorporation to percutaneous nephrolithotomy (PCNL), residual stone fragments (RSF) may still persist after PCNL and need to be addressed to avoid re-growth or ureteral obstruction. The objective of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) to shock wave lithotripsy (SWL) for treating patients with residual stone fragments after a previous standard PCNL.
Adult patients with RSF after a standard PCNL submitted to RIRS or SWL in our Institution from January 2017 to January 2020 were retrospectively studied. Stone-free rate (SFR) was evaluated on POD 90 by non-contrast computerized tomography (NCCT) or ultrasound and kidney-bladder-ureter radiography (KUB) for each renal unit. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Sample size was calculated for a power of 80% and a significance level of 0.05, assuming SFR of 20% for SWL and 50% for RIRS.
Thirty-three patients treated by SWL were compared to 36 patients treated by RIRS. Hospitalization time was longer in the RIRS group (4.18h vs. 12.33h, p=0.001). SFR and success rate were lower in SWL than RIRS group (24.2% vs. 58.3%, p=0.007 and 30.3% vs. 72.2%, p=0.004, respectively), using POD 90 NCCT in 81.8% and ultrasound and KUB in 18.2% of the SWL group and using POD 90 NCCT in 100% of the RIRS group. Minor complications (Clavien-Dindo < III) occurred in 11/36 (30.6%) patients submitted to RIRS and in 2/33 (6.1%) patients submitted to SWL group (p=0.025). Two patients (6.1%) of the SWL group had Clavien-Dindo IIIb complication due to steinstrasse and were submitted to ureteroscopy. Emergency room visits were similar between groups (6.1% vs. 8.3%, p=1.0).
RIRS has better SFR, higher minor complications and lower major complications than SWL for the treatment of RSF after standard PCNL.
Journal of endourology. 2020 Oct 23 [Epub ahead of print]
Alexandre Danilovic, Fabio Torricelli, Giovanni Scala Marchini, Carlos Batagello, Fabio Carvalho Vicentini, Olivier Traxer, Miguel Srougi, William Carlos Nahas, Eduardo Mazzucchi
Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, Sao Paulo, Brazil, 05403-000; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology São Paulo, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Section of Endourology, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Urology, Sao Paulo, São Paulo, Brazil., Hopital Tenon, 55705, Urology, Paris, Île-de-France, France; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Sao Paulo, São Paulo, Brazil; .