1810 PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR MODERATE SIZED KIDNEY STONES

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20101810 PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR MODERATE SIZED KIDNEY STONES Samuel Deem, Julio Davalos, Brian DeFade, and Fred Martinez Samuel DeemSamuel Deem Charleston, WV More articles by this author , Julio DavalosJulio Davalos Charleston, WV More articles by this author , Brian DeFadeBrian DeFade Chapel Hill, NC More articles by this author , and Fred MartinezFred Martinez Charleston, WV More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1735AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Extracorporeal shock wave lithotripsy has been the standard therapy recommended for most kidney stones since its arrival in the early 1980's. Percutaneous nephrolithotomy and ureteroscopy techniques are rapidly gaining popularity as re-treatment rates for stones following lithotripsy have risen with the 3rd and 4th generation lithotripters currently in use. Our excellent experience with percutaneous techniques make us question lithotripsy as the current standard treatment for moderate sized,(10-20 millimeter) upper and middle pole stones. CT has become the gold standard for determining stone-free status following treatment. Outcomes today are more focused toward patient quality of life and satisfaction instead of physician rated outcomes. The objectives of this study are to review stone-free status based on CT, need for additional procedures, morbidity, and quality of life and compare these outcomes between two treatment groups; Percutaneous nephrolithotomy (PNL) and Extracorporeal shockwave lithotripsy (ESWL). METHODS Prospective trial of patients found by CT scan to have a 10-20 mm upper or middle pole kidney stone meeting inclusion and exclusion criteria. All candidates were randomized into either PNL or ESWL for treatment after filling out the SF-8 quality of life questionnaire. Both procedures utilize general anesthesia and ureteral stenting prior. Follow-up consists of returning at 1 week with KUB and at 3 months with non-contrast CT scan. The SF-8 questionnaire was completed at both visits. All complications and need for additional procedures were recorded. Quality of life data was collected and compared. RESULTS PCNL significantly increased the establishment of stone-free status at both 1 week and 3 months. ESWL more frequently required a retreatment versus PCNL. Overall complications at five time intervals were similar between treatment groups. Patient perceived quality of life demonstrated similar physical scores at 3 months however, the mental scores were improved in the PCNL group but not in the ESWL group. CONCLUSIONS PNL techniques and equipment are developing at a rapid pace. These refinements in technique are what allow a more invasive procedure to be done with both better results and more patient satisfaction. We believe that less stress is placed on the PNL patient knowing they are stone free leading to higher patient satisfaction on SF-8. These moderate sized stones are much easier to remove by a percutaneous procedure than larger stones allowing less complications and better outcomes. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e702-e703 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Deem Charleston, WV More articles by this author Julio Davalos Charleston, WV More articles by this author Brian DeFade Chapel Hill, NC More articles by this author Fred Martinez Charleston, WV More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...