title: Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes.
abstract: OBJECTIVE
  To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion.
  
  
  METHODS
  Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared.
  
  
  RESULTS
  Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL.
  
  
  CONCLUSIONS
  For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.
authors.affiliation: Department of Urology, King George Medical University, Lucknow, India.
authors.forename: Bhupendra Pal
authors.initials: BP
authors.lastname: Singh
authors.affiliation: Department of Urology, King George Medical University, Lucknow, India. Electronic address: drjpswami@gmail.com.
authors.forename: Jai
authors.initials: J
authors.lastname: Prakash
authors.affiliation: Department of Urology, King George Medical University, Lucknow, India.
authors.forename: Satya Narayan
authors.initials: SN
authors.lastname: Sankhwar
authors.affiliation: Department of Rheumatology, King George Medical University, Lucknow, India.
authors.forename: Urmila
authors.initials: U
authors.lastname: Dhakad
authors.affiliation: Department of Obstetrics and Gynecology, King George Medical University, Lucknow, India.
authors.forename: Pushp Lata
authors.initials: PL
authors.lastname: Sankhwar
authors.affiliation: Department of Urology, King George Medical University, Lucknow, India.
authors.forename: Apul
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Urology, King George Medical University, Lucknow, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D007670:Kidney Calices; D008096:Lithotripsy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome