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Page 1: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed
Page 2: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

Title:

Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm

Single Renal Pelvis Stone

Authors: Mohammed Hassan, Ahmed R. EL-Nahas, Khaled Z.

Sheir, Nasr A. El-Tabey, Ahmed M. El-Assmy and Ahmed A. Shokeir

Affiliation:

Urology Department, Urology and Nephrology Center,

Mansoura University, Mansoura, Egypt

Page 3: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

Aim of the studyAim of the study

To compare the efficacy, safety and cost of

extracorporeal shockwaves lithotripsy (SWL)

and percutaneous nephrolithotomy (PNL) in

treatment of a 20-30 mm single renal pelvis

stone.

Page 4: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

Patients and MethodsPatients and Methods

Retrospective Study Between January 2006 and December 2012 Exclusion criteria:

– Patients aged <18 years, – Branched stone– Advanced hydronephrosis, – Solitary kidney, anatomical renal abnormality– Received treatment for this stone within the

past 6 months.

Page 5: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

In PNL group: – Prone positionProne position– Fluoroscopic guided renal punctureFluoroscopic guided renal puncture– Dilatation with Alken’s metal dilator to 30 FDilatation with Alken’s metal dilator to 30 F– Disintegrated: ultrasonic or pneumaticDisintegrated: ultrasonic or pneumatic– A 22 F nephrostomy tube was placed and left A 22 F nephrostomy tube was placed and left

for 24-48 hours for 24-48 hours

Patients and MethodsPatients and Methods

Page 6: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

In SWL group:

– Electromagnetic Dornier lithotripter S (Dornier Electromagnetic Dornier lithotripter S (Dornier MedTech GmbH, Germering, Germany) was MedTech GmbH, Germering, Germany) was used. used.

– Shockwaves were delivered at a rate of 80 Shockwaves were delivered at a rate of 80 shocks/minutes till a maximum of 3000 shocks/minutes till a maximum of 3000 shocks per session. shocks per session.

Patients and MethodsPatients and Methods

Page 7: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

Evaluation

The stone free status was evaluated 3 months after PNL or last SWL session by NCCT.

Success included patients who became stone free or had insignificant residual (4 mm or less).

Comparison: The 2 groups were compared for:

Re-treatment rate, secondary procedures The costs of primary and secondary procedures

Patients and MethodsPatients and Methods

Page 8: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

ResultsResults

Page 9: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

SWL 167 Patients

PNL 170 Patients

P

Patients characters

Age (years) Mean ± SD 47.7 ± 11.7 50.9 ± 12.4 0.018

BMI Mean ± SD 31.6 ± 4.6 31.9 ± 7.4 0.589

Stone character

Side 0.449

RightLeft

77 (46%)90 (54%)

84 (49.4%)86 (50.6%)

Largest diameter (mm) 23.5 ± 2.7 25.1 ± 3 < 0.001

Stone surface area (mm2) 295 ± 100 383 ± 136 < 0.001

SSD (cm, mean ± SD) 9.9 ± 1.9 10.6 ± 2.5 0.011

Attenuation value (HU) 826 ± 353 740 ± 359 0.122

Page 10: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

SWL 167 Patients

PNL 170 Patients

P

Efficacy N. (%) N. (%)

Success 115 (75%) 162 (95.3%) < 0.001

Re-treatment 126 (75.4%) 9 (5.3%) < 0.001

Secondary procedure

42 (25%) 8 (4.7%) < 0.001

ResultsResults

Page 11: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

SWL 167 Patients

PNL 170

Patients

P

Safety N. (%) N. (%)

Complications(Clavien Class.)

overallG I

G IIG IIIa

11 (6.6)0 (0)

4 (2.4)7 (4.2)

22 (12.9)7 (4.1)6 (3.5)9 (5.3)

0.050

Total Cost ($US) < 0.001

Median (Range)

490(350-1820)

1120(1118-1750)

ResultsResults

Page 12: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed

ConclusionsConclusions

For treatment of a single renal pelvis stone

of 20-30 mm:

– PNL was more effective than SWL. PNL was more effective than SWL.

– SWL had lesser complications and SWL had lesser complications and

lower cost. lower cost.

Page 13: Title: Percutaneous Nephrolithotomy versus Extracorporeal Shockwaves Lithotripsy for Treatment of a 20-30 mm Single Renal Pelvis Stone Authors: Mohammed