title: Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.
abstract: OBJECTIVE
  To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone.
  
  
  METHODS
  The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20-81) years. The patients' criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared.
  
  
  RESULTS
  In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001).
  
  
  CONCLUSIONS
  PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: El-Nahas
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Khaled Z
authors.initials: KZ
authors.lastname: Sheir
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Nasr A
authors.initials: NA
authors.lastname: El-Tabey
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: El-Assmy
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
keywords: BMI, Body mass index; Cost; Extracorporeal shockwaves lithotripsy; PNL, Percutaneous nephrolithotomy; Percutaneous nephrolithotomy; RIRS, Retrograde intrarenal surgery; SFR, Stone-free rate; Single renal stone