A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience

• Published in: World journal of urology Vol. 35; no. 12; pp. 1967 - 1975
• Main Authors: Bozzini, G, Verze, P, Arcaniolo, D, O Dal Piaz, Buffi, N M, Guazzoni, G, Provenzano, M, Osmolorskij, B, Sanguedolce, F, Montanari, E, Macchione, N, Pummer, K, Mirone, V, De Sio, M, Taverna, G
• Format: Journal Article
• Language: English
• Published: Berlin Springer Nature B.V 01-12-2017
• Subjects: Computed tomography; Data processing; Radiography; Uric acid
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-017-2084-7

PurposeTo prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm.Materials and methodsPatients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed.ResultsThe mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C (p = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min (p = 0.082)], fluoroscopic time [175.6 vs. 31.8 min (p = 0.004)] and hospital stay [3.7 vs. 1.3 days (p = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% (p < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C (p < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively.ConclusionsRIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay.ISRCTN 55546280.