Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery for renal pelvis stone of 1-2 cm: a randomized clinical trial

Abstract

Introduction: Urolithiasis is a common medical problem, having the probability to recur within 10 years. The choice of initial stone removal procedure has been established as a factor in recurrence of disease through enabling a stone-free period. There is a dearth of local studies on this topic to address the choice of initial stone removal procedure.

Objective: To compare the stone-free rate following Extracorporeal Shock Wave Lithotripsy (ESWL) and Retrograde Intra Renal Surgery (RIRS) for renal pelvic stone of 1-2 cm.

Materials & Methods: This randomized clinical trial was conducted in the Department of Urology, Lady Reading Hospital MTI, Peshawar, over a period of six months (July to December 2021) on 60 patients of renal pelvis stones, randomized equally into Group A (ESWL) and Group B (RIRS). In Group A parenteral analgesic was administered for pain relief. The ESWL was performed with patients in supine and lateral position while for Group B general anesthesia was administered. The RIRS was performed with patients in Supine Lithotomy position. All patients were investigated using Ultrasound and X-ray KUB (Kidney, Ureter, Bladder) done by senior sonologist of the hospital and CT KUB without contrast to confirm the presence of stones, their size and location. Ultrasound and X-ray KUB were obtained one month post-operative day of procedure to assess the clearance of stone in each group. Data were analyzed for descriptive and comparative statistics by SPSS 20.

Results: The mean age in Group A was 41 ± 10.67 years, and in Group B it was 42 ± 9.09 years. In Group A 20(67%) patients were male and 10(33%) patients were female; in Group B 21(70%) patients were male and 9(30%) patients were female. At one month postoperative follow-up, Group A had 10(33%) stone-free patients, and 20(67%) patients not stone-free. Group B had 22(73%) stone-free patients, and 8(27%) patients who were not stone-free. These differences of stone-free frequencies among the groups were statistically significant (p<0.05).

Conclusion: The stone-free rate was significantly decreased in Extracorporeal Shock Wave Lithotripsy patients as compared to Retrograde Intrarenal Surgery patients for renal pelvic stone of 1-2 cm.