title: A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: a single center experience.
abstract: OBJECTIVE
  A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for the treatment of 1 to 2 cm radiolucent lower calyceal renal calculi was done to evaluate the safety and efficacy of these procedures.
  
  
  METHODS
  Patients with a single 1 to 2 cm radiolucent lower calyceal renal stone who underwent treatment between January 2012 and May 2013 were included in study. They were randomized to shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Patient demographic profiles, success and re-treatment rates, auxiliary procedures and complications were analyzed.
  
  
  RESULTS
  A total of 45 patients were enrolled in each of the shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Three, 2 and 4 patients, respectively, were excluded from final analysis due to a matrix stone diagnosis. Mean procedure and fluoroscopy times were significantly greater in the miniperc group than in the other groups. Hospital stay (3.1 days vs 3.1 hours and 1.3 days, p = 0.01) and the blood transfusion rate (13.3% vs 0% and 0%, p = 0.03) were significantly higher for miniperc vs shock wave lithotripsy and retrograde intrarenal surgery, respectively. The re-treatment rate (63.4% vs 2.1% and 2.2%, p <0.001) and the auxiliary procedure rate (20.2% vs 8.8% and 6.6%, p = 0.02) were significantly greater for shock wave lithotripsy than for retrograde intrarenal surgery and miniperc, respectively. The 3-month stone-free rate of shock wave lithotripsy, retrograde intrarenal surgery and miniperc was 73.8% (31 of 42 patients), 86.1% (37 of 43) and 95.1% (39 of 41), respectively (p = 0.01).
  
  
  CONCLUSIONS
  Miniperc and retrograde intrarenal surgery were more effective than shock wave lithotripsy to treat 1 to 2 cm radiolucent lower calyceal renal calculi in terms of a better stone-free rate, and lesser auxiliary and re-treatment rates. However, miniperc resulted in more complications, greater operative time and radiation exposure, and a longer hospital stay.
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India. Electronic address: anup_14k@yahoo.com.
authors: Anup
authors: A
authors: Kumar
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
authors: Niraj
authors: N
authors: Kumar
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
authors: Pawan
authors: P
authors: Vasudeva
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
authors: Sanjeev
authors: S
authors: Kumar Jha
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
authors: Rohit
authors: R
authors: Kumar
authors: Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
authors: Harbinder
authors: H
authors: Singh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D007670:Kidney Calices; D008096:Lithotripsy; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography
keywords: kidney; lithotripsy; nephrolithiasis; nephrostomy; operative; percutaneous; surgical procedures