Comparison of SWL and RIRS in Lower Calyceal Stones
Science Journal of Clinical Medicine
Volume 2, Issue 6, November 2013, Pages: 166-170
Received: Sep. 20, 2013; Published: Nov. 10, 2013
Views 2920      Downloads 168
Basri Cakiroglu, Hisar Intercontinental Hospital, Department of Urology, 34768 Umraniye, Istanbul, Turkey
Tuncay Tas, Taksim Training and Research Hospital, Department of Urology, 34433 Taksim, Istanbul, Turkey
Seyit Erkan Eyyupoglu, Sabuncuoglu Serefettin Training and Research Hospital, Department of Urology, 05200 Amasya, Turkey
Aydin Ismet Hazar, Taksim Training and Research Hospital, Department of Urology, 34433 Taksim, Istanbul, Turkey
M. Bahadir Can Balci, Taksim Training and Research Hospital, Department of Urology, 34433 Taksim, Istanbul, Turkey
Suleyman Hilmi Aksoy, Hisar Intercontinental Hospital, Department of Radiology, 34768 Umraniye, Istanbul,Turkey
Bekir Sami Uyanik, Hisar Intercontinental Hospital, Department of Clinical Biochemistry, 34768 Umraniye, Istanbul, Turkey
Article Tools
Follow on us
Background: The efficacy of extracorporeal shock wave lithotripsy(SWL) in kidney stones in the lower calices was compared using retrograde intrarenal surgery(RIRS). Methodology And Materials: Between January 2008 and May 2011, 64 patients (40 male and 24 female) undergoing SWL and 60 patients (38 male 22 female) undergoing flexible URS were analyzed retrospectively, and success rates were compared. Using the Storz Medical Modulith SLK, patients underwent the SWL process prior to the induction of anesthesia. On the other hand, the 8 f Storz flex X2 flexible URS was used for URS after general anesthesia and RIRS. During the RIRS process, stones were crushed using the 0.2 mm diameter holmium: YAG laser probe, and stone fragments larger than 2 mm were extracted. In some cases, double J or ureteral catheters were placed in the ureter. Results: In the 64 patients undergoing SWL with lower caliceal stones, the following ranges were noted: stone diameter: 6-35 mm (mean 15.9 mm), age: 16-72 years (mean , sessions required: 1-4 sessions (mean: 1.6), the number of shots: 1000-7650 (mean: 4124.6), fire intensity: 25-75 (mean: 60). Ten percent of patients required analgesia, and the success rate of the procedure was 87.5%. Hematuria occurred in 65% of patients as a minor complication and in 2%,streinstrasse occurred as a major complication. Inpatients undergoing RIRS, the following ranges were noted: stones size: 7-30 mm in diameter (average 15.2 mm), age: 21-60 years (mean 39.75),duration of operation: 30-85 minutes(mean: 48.8 minutes), respectively. An access sheath was used in all 32 patients. Balloon dilation was performed in 8 patients with distal ureteral stenosis, and a double J catheter was placed in 2 patients because of stenosis in the upper ureter and four weeks later, the stones were treated with fURS. Patients were discharged on an average of 1.2 days (1-3 days). A ureteral laceration was noted in 30% of patients while 75% of patients had hematuria. Partial ureteral avulsion occurred in one patient with an overall success rate of 96.4%. Conclusions: During the treatment of lower caliceal stones, the success and complication rate of RIRS is higher than SWL.
Lower Calyceal Stones, SWL, RIRS, Holmium YAG Laser, Laser Lithotripsy
To cite this article
Basri Cakiroglu, Tuncay Tas, Seyit Erkan Eyyupoglu, Aydin Ismet Hazar, M. Bahadir Can Balci, Suleyman Hilmi Aksoy, Bekir Sami Uyanik, Comparison of SWL and RIRS in Lower Calyceal Stones, Science Journal of Clinical Medicine. Vol. 2, No. 6, 2013, pp. 166-170. doi: 10.11648/j.sjcm.20130206.14
Göğüş Ç, Böbrek Alt Kalis Taşlarında Tedavi.Turkiye Klinikleri J.Med.Sci.2006; 2(4):10-12
Marshall V: Fiberoptics in Urology. J Urol 1964; 160:110-4
Stav K, Cooper A, Zisman A, Leibovici D, Lindner A, Sie¬gel YI. Retrograde intrarenal lithotripsy outcome after fai¬lure of shock wave lithotripsy. J Urol;2003; 170:2198-201,
Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. Prospective, randomized trial com¬paring shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol;2005; 173:2005-9, 2005
Johnston WK 3 rd, Low RK, Das S. The evolution and progress of ureteroscopy. UrolClin North Am 2004;31,5-13
Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. A Randomized Controlled Study to Analyze the Safety and Efficacy of Percutaneous Nephrolithotripsy and Retrograde Intrarenal Surgery in the Management of Renal Stones More Than 2 cm in Diameter J Endourol. 2012 Jan; Volume 26, Number 1, Pp. 52–57
Wiesenthal JD, Ghiculete D, D’A. Honey RJ, Chir B. Pace KT. A Comparison of Treatment Modalities for Renal Calculi Between 100 and 300mm2:Are Shockwave Lithotripsy, Ureteroscopy,and Percutaneous NephrolithotomyEquivalent?JEndourol. 2011 Mar; Volume 25, Number 3, Pp. 481–485
Me´ndez Probst CE, Denstedt JD, Razvi H. Preoperative Indications for Percutaneous Nephrolithotripsy in 2009.J Endourol.2009 Oct;Volume 23, Number 10, Pp. 1557–1561
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm.BJU Int. 2012 Sep;110(6):898-902
Hyams ES, Munver R, Bird VG, Uberoi J, Shah O. Flexible Ureterorenoscopy and Holmium Laser Lithotripsy for the Management of Renal Stone Burdens That Measure 2 to 3 cm: A Multi-Institutional Experience. Journal of Endourology 2010 Oct; Volume 24, Number 10, Pp. 1583–1588.
Aboumarzouk OM, Monga M, Kata SG, Traxer O, Soman BK. Flexible Ureteroscopy and Laser Lithotripsy for Stones > 2 cm: A Systematic Review and Meta-Analysis Journal of Endourology.2012 Oct; Volume 26, Number 10, Pp. 1257–1263
Harmon WJ, Sershon PD, Blute ML, et al. Ureteroscopy:Current practice and long-term complications. J Urol.1997;157:28–32.
Ge C, Li Q, Wang L, Jin F, Li Y, Wan J, Lan W et al. Management of Complete Ureteral Avulsion and Literature Review: A Report on Four Cases Journal of Endourology. 2011 Feb; 25(2): 323-326
Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C et al. Postureteroscopic Lesion Scale: A New Management Modified Organ Injury Scale—Evaluation in 435 Ureteroscopic Patients. Journal of Endourology 2012;26.11, 1425-1430
AkmanT,Binbay M, Ugurlu M, Kaba M, Akcay M, Yazici O et al.Outcomes of Retrograde Intrarenal Surgery Compared with Percutaneous Nephrolithotomy in Elderly Patients with Moderate-Size Kidney Stones: A Matched-Pair Analysis.Journal of Endourology.2012 June; Volume 26, Number 6, Pp. 625–629
Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol. 1999 Dec;162(6):1904-8
Elbahnasy AM, Shalhav AL, Hoenig DM, Elashry OM, Smith DS, McDougall EM, Clayman RV. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy.J Urol. 1998 Mar;159(3):676-82
Elbahnasy AM, Clayman RV, Shalhav AL, Hoenig DM, Chandhoke P et al. Lower-Pole Caliceal Stone Clearance after Shockwave Lithotripsy, Percutaneous Nephrolithotomy, and Flexible Ureteroscopy: Impact of Radiographic Spatial Anatomy. Journal of Endourology 1998;April, Volume 12, Number 2
Resorlu B, Oguz U, Resorlu EB, Oztuna D, Unsal A. The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology. 2012 Jan;79(1):61
Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20mm.Journal of Endourology. 2011;25,1131–1135.
Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR Management of lower pole nephrolithiasis: a critical analysis. J Urol. 1994 Mar;151(3):663-7
Ozgur Tan M, Irkilata L, Sen I, Onaran M, Kupeli B, Karaoglan U, et al. The impact of radiological anatomy in clearance of lower caliceal stones after shock wave lithotripsy. Urol Res. 2007;35.143–7
Ghoneim IA, Ziada AM, Elkatib SE. Predictive factors of lower calyceal stone clearance after Extracorproeal Shockwave Lithotripsy (ESWL): A focus on the infundibulopelvic anatomy. Eur Urol. 2005;48:296–302
Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M. Et al. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol. 2001 Dec;166(6):2072-80
Grasso M, Bagley D.Small diameter, actively deflectable, flexible ureteropyeloscopy. J Urol. 1998 Nov; 160(5):1648-53; discussion 1653-4
Schoenthaler M, Wilhelm K, Katzenwadel A, ArdeltP,Wetterauer U et al. Retrograde Intrarenal Surgery in Treatment of Nephrolithiasis:Is a 100% Stone-Free Rate Achievable? Journal of Endourology.2012 May; Volume 26, Number 5, Pp. 489–493
Hussain M, Acher P, Penev B, Cynk M. Redefining the Limits of Flexible Ureterorenoscopy.Journal of Endourology 2011 Jan; Volume 25, Number 1, Pp. 45–49
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186