title: Immediate versus delayed shockwave lithotripsy for inaccessible stones after uncomplicated percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2were excluded from the study. The following data were reported: patients' demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR).
  
  
  RESULTS
  In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients' demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P< 0.001). The duration of ureteric stenting was significantly lower in Group I as compared to Group II, at a mean (SD) of 12 (4.2) vs 25 (3.5) days (P< 0.001). The SFR was 93.2% and 95% in Groups I and II, respectively (P= 0.9).
  
  
  CONCLUSIONS
  Immediate SWL after PCNL is as effective and safe as delayed SWL with a lesser hospital stay and duration of ureteric stenting.
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Esam A E
authors.initials: EA
authors.lastname: Desoky
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Amr M
authors.initials: AM
authors.lastname: Fawzi
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sakr
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eliwa
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Ehab R
authors.initials: ER
authors.lastname: El Sayed
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Diab
authors.initials: D
authors.lastname: El Sayed
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Asharf M S
authors.initials: AM
authors.lastname: Shahin
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Salem
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Hussien M
authors.initials: HM
authors.lastname: Kamel
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Shabana
authors.affiliation: Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Kamel
keywords: BMI, body mass index; CONSORT, Consolidated Standards of Reporting Trials; Delayed; HU, Hounsfield unit; Immediate; KUB, plain abdominal radiograph of the kidneys, ureters and bladder; PCNL, percutaneous nephrolithotomy; Percutaneous nephrolithotomy; SFR, stone-free rate; SWL; SWL, shockwave lithotripsy; US, ultrasonography