title: Interventional stress in renal stone treatment.
abstract: OBJECTIVE
  To compare current minimally invasive strategies in renal stone treatment-shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and minimally invasive percutaneous nephrolitholapaxy-with regard to interventional stress, measured by changes in interleukin (IL)-6 and C-reactive protein (CRP) serum levels during treatment.
  
  
  METHODS
  143 patients underwent stone therapy for renal pelvic stone (SWL, n=40, mean age±standard error of the mean [SEM]: 48.3±3.1 years; RIRS, n=74, 54.5±1.8; and minimally invasive percutaneous nephrolitholapaxy (MIP), n=29, 54.6±2.7) between 2006 and 2007. Blood samples were prospectively collected 24 hours before and 24 hours after the procedure. Interventional stress was analyzed by changes of the acute phase proteins IL-6 and CRP.
  
  
  RESULTS
  Mean IL-6 (ng/L) difference (±SEM; 95% confidence interval [CI]) before and after therapy was +8.7 (±10.5; -13.9-31.2), +7.3 (±3.2; 1.5-13.1), and +20.5 (±8.1; 4.0-36.0) in the SWL, RIRS, and MIP groups, respectively (P=0.20). Differences in mean CRP (mg/dL) levels (±SEM; 95% CI) ranged between +0.9 (±1.6; -2.3-4.1) in SWL, +1.6 (±0.5; 0.6-2.5) in RIRS, and +1.8 (±,0.3, 1.2-2.5) in MIP patients (P=0.79). Mean stone sizes (mean/median mm(2)±SEM) differed significantly between SWL (27/20±3), RIRS (70/16±36), and MIP groups (346/160±104, P<0.0005).
  
  
  CONCLUSIONS
  Contrary to common opinion that SWL is the least invasive therapy, the reported stress parameters did not show significant differences between SWL, RIRS, and MIP, although significantly bigger stones were treated with MIP.
authors.affiliation: Department of Urology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruck
authors.forename: Markus
authors.initials: M
authors.lastname: Sonnleithner
authors.forename: Joerg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Ute
authors.initials: U
authors.lastname: Walcher
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D003710:Demography; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007669:Kidney Calculi / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D013312:Stress, Physiological
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein