INTRODUCTION: The purpose of the study was to compare the outcome of flexible ureteroscopy (URS) and percutaneous nephrolitripsy (PCNL) following failure of extracorporeal shock wave lithotripsy (ESWL) for patients with renal stones.
METHODS: Participants were 66 adult patients with renal stones 8-20 mm in diameter. All patients had failed ESWL after a maximum of 2 sessions. Patients were assigned to treatment groups according to their choice. A total of 39 patients chose URS and 27 patients chose PCNL. Group differences in outcome measures were determined using Mann-Whitney and chi-square tests.
RESULTS: URS was technically successful in 31 cases; conversion to PCNL was done for the remaining 8 cases. The mean (standard deviation) operative time of 65 (15) minutes for the PCNL procedure was significantly shorter than the operative time of 115 (16) minutes for URS (P < .001). Conversely, the mean hospital stay of 1.19 (0.4) days and 1.09 (0.3) postoperative analgesic injections for the patients receiving URS were significantly shorter than the hospital stay of 5.28 (1.1) days and 3.2 (0.6) injections for the patients receiving PCNL (both P < .001). Revision of URS was needed in 4 cases; 2 of these patients became stone-free. One month postoperatively, the stone-free rate was 61% and 77% after URS and PCNL, respectively (P = .162). No patient in either group had significant complications.
CONCLUSIONS: Although the operative time was shorter for PCNL, URS is superior in terms of hospital stay and postoperative pain. Stone-free rates were not significantly different. These results help justify the preference of URS for treatment of kidney stones after failure of ESWL.
KEYWORDS: Kidney stones; Flexible URS; PCNL.
CORRESPONDENCE: Yehya Hassan ElShebiny MD, Division of Urology, Department of Surgery, Adan Hospital, Fahaheel, PO Box 46496, Kuwait City, 64015, Kuwait ().
CITATION: Urotoday Int J. 2010 Aug;3(4).
doi:10.3834/uij.1944-5784.2010.08.13