title: Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less.
abstract: OBJECTIVE
  The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.
  
  
  METHODS
  A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome parameters were length of stay, complication rates, need for secondary procedures and patient derived quality of life measures.
  
  
  RESULTS
  A total of 67 patients randomized to SWL (32) or URS (35) completed treatment. The 2 groups were comparable with respect to age, sex, body mass index, side treated and stone surface area. Operative time was significantly shorter for SWL than URS (66 vs 90 minutes). At 3 months of followup 26 and 32 patients who underwent SWL and URS had radiographic followup that demonstrated a stone-free rate of 35% and 50%, respectively (p not significant). Intraoperative complications occurred in 1 SWL case (unable to target stone) and in 7 URS cases (failed access in 5 and perforation in 2), while postoperative complications occurred in 7 SWL and 7 URS cases. Patient derived quality of life measures favored SWL.
  
  
  CONCLUSIONS
  This study failed to demonstrate a statistically significant difference in stone-free rates between SWL and URS for the treatment of small lower pole renal calculi. However, SWL was associated with greater patient acceptance and shorter convalescence.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. margaret.pearle@utsouthwestern.edu
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Pearle
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.forename: Raymond
authors.initials: R
authors.lastname: Leveillee
authors.forename: Ramsay
authors.initials: R
authors.lastname: Kuo
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
authors.forename: Joseph
authors.initials: J
authors.lastname: Macaluso
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.forename: Udaya
authors.initials: U
authors.lastname: Kumar
authors.forename: John
authors.initials: J
authors.lastname: Dushinski
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.forename: Dean
authors.initials: D
authors.lastname: Assimos
authors.forename: Michael
authors.initials: M
authors.lastname: Fabrizio
authors.forename: Larry C
authors.initials: LC
authors.lastname: Munch
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Nakada
authors.forename: Brian
authors.initials: B
authors.lastname: Auge
authors.forename: John
authors.initials: J
authors.lastname: Honey
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.forename: John
authors.initials: J
authors.lastname: Pattaras
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Averch
authors.forename: Thomas
authors.initials: T
authors.lastname: Turk
authors.forename: Paul
authors.initials: P
authors.lastname: Pietrow
authors.forename: Stephanie
authors.initials: S
authors.lastname: Watkins
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D007670:Kidney Calices / Q000000981:diagnostic imaging; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D018666:Ureteroscopy; D014567:Urography