Back to Program


Management of Lower Pole Stones: Ureterorenoscopy vs. Tubeless PCNL vs. Shockwave Lithotripsy
Michael S. Lasser, MD, Sutchin Patel, MD, Haleblian E. George, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.

BACKGROUND
Lower pole stones data suggest that tubeless percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) and shockwave lithotripsy (SWL) are available treatment modalities for stones less than 1.5 cm. Previously, we reported that tubeless PCNL may be more efficacious than the other modalities. As more experience has been gained, an updated analysis was performed to evaluate the efficacy of front line URS, SWL, or tubeless PCNL for treatment of lower pole stones.
METHODS
60 patients undergoing treatment of 0.5 to 1.5 cm lower pole calculi were reviewed (2007-2009). Of these, 15 underwent tubeless PCNL, 25 URS and 20 SWL. Demographic data, stone size, Hounsfield units (HU), and skin to stone distance (SSD) were measured in each cohort. The stone free (SF) status (no residual calculi) of patients was determined by post-treatment imaging (CT scan or KUB) at 6 weeks. In addition, the number of auxiliary procedures to clear calculi and the number of complications in each group were tabulated. Statistical analysis was performed to evaluate for significant difference in SF rates and the number of auxiliary procedures.
RESULTS
Between the three cohorts, there was no statistically significant difference in demographics, HU and SSD. The mean stone size was 0.9 cm, 0.9 cm, 1.2 cm for the SWL, URS and tubeless PCNL groups respectively (p>0.05). There was a significant difference between the stone free rates in the tubeless PCNL group (100%) and SWL Group (33%) (p<0.05). There was no significant difference in stone free rates between the tubeless PCNL group and URS group. The number of auxiliary procedures in the SWL cohort (n = 9) was significantly greater than in the URS (n = 2) and tubeless PCNL (n = 0) groups. Mean hospital stay for tubeless PCNL patients was 1.2 days (URS and SWL were both done as outpatient procedures). No major complications were observed in any of the treatment groups. There were no minor complications in the URS and tubeless PCNL groups. SWL group had 2 minor complications (1 UTI, 1 renal colic requiring admission).
CONCLUSIONS
URS and tubeless PCNL have a high success rate in patients with lower pole stones and are equally efficacious treatment modalities for stones between 0.5mm and 1.5cm. URS is an ambulatory procedure that can be performed with minimal additional morbidity and may be offered as first line treatment.


Back to Program