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Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy

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Abstract

Purpose

There is a lack of studies comparing shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) in renal stone treatment. This study compared treatment outcome, stone-free rate (SFR) and stone-free survival (SFS) with regard to stone size and localization.

Methods

This analysis included 482 first-time-treated patients in the period 2001–2007. Detailed clinical information, stone analysis and metabolic evaluation were evaluated retrospectively. Outcome, SFR and SFS were analyzed with regard to size (<1 vs. ≥1 cm) and localization (lower vs. non-lower pole).

Results

Higher SFRs in lower and non-lower pole stones ≥1 cm were confirmed for RIRS and MIP (p < 0.0001). A regression model confirmed a higher risk of non-lower pole stone persistence for SWL versus RIRS (OR: 2.27, p = 0.034, SWL vs. MIP (OR: 3.23, p = 0.009) and larger stone burden ≥1 versus <1 cm (OR: 2.43, p = 0.006). In accordance, a higher risk of residual stones was found in the lower pole for SWL versus RIRS (OR: 2.67, p = 0.009), SWL versus MIP (OR: 4.75, p < 0.0001) and stones ≥1 cm versus <1 cm (OR: 3.02, p = 0.0006). In RIRS and MIP patients, more complications, stenting, prolonged disability, need/duration of hospitalization and analgesia were noticed (p < 0.05). Overall SFS increased from SWL, RIRS, to MIP (p < 0.001). SWL showed lower SFS for non-lower pole (p = 0.006) and lower pole stones (p = 0.007).

Conclusions

RIRS and MIP were shown to have higher stone-free rates and SFS compared to SWL. The price for better outcome was higher, considering tolerable complication rates. Despite larger preoperative stone burden, MIP achieved high and long-term treatment success.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, University of Tuebingen, Tübingen, Germany

    Stephan Kruck, Mohamed F. Abdelhafez, Lillian Hölzle, David Schilling, Jens Bedke & Arnulf Stenzl

  2. Department of Urology, University of Rostock, Rostock, Germany

    Aristoteles G. Anastasiadis

  3. Department of Urology, Hannover Medical School, Hannover, Germany

    Thomas R. W. Herrmann

  4. Department of Urology, General Hospital Hall i.T., Milser Straße 10–12, 6060, Hall in Tirol, Austria

    Ute Walcher, André P. Nicklas & Udo Nagele

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  1. Stephan Kruck
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  2. Aristoteles G. Anastasiadis
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  3. Thomas R. W. Herrmann
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Correspondence to Udo Nagele.

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Kruck, S., Anastasiadis, A.G., Herrmann, T.R.W. et al. Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World J Urol 31, 1555–1561 (2013). https://doi.org/10.1007/s00345-012-0962-6

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  • DOI: https://doi.org/10.1007/s00345-012-0962-6

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