title: Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones.
abstract: OBJECTIVE
  To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10-20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications.
  
  
  METHODS
  A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group.
  
  
  RESULTS
  Success rates were 66.5, 91.4, and 87% for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7%, respectively; p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9%, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively).
  
  
  CONCLUSIONS
  For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.
authors.affiliation: , Ankara, Turkey, drberkan79@gmail.com.
authors.forename: Berkan
authors.initials: B
authors.lastname: Resorlu
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ziypak
authors.forename: Akif
authors.initials: A
authors.lastname: Diri
authors.forename: Gokhan
authors.initials: G
authors.lastname: Atis
authors.forename: Selcuk
authors.initials: S
authors.lastname: Guven
authors.forename: Ahmet Ali
authors.initials: AA
authors.lastname: Sancaktutar
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Omer Faruk
authors.initials: OF
authors.lastname: Bozkurt
authors.forename: Derya
authors.initials: D
authors.lastname: Oztuna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007669:Kidney Calculi / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult