A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience

Bozzini, G.; Verze, P.; Arcaniolo, D.; Dal Piaz, O.; Buffi, N.; Guazzoni, G.; Provenzano, M.; Osmolorskij, B.; Sanguedolce, F.; Montanari, E.; Macchione, N.; Pummer, K.; Mirone, V.; Sio, M.; Taverna, G.
December 2017
World Journal of Urology;Dec2017, Vol. 35 Issue 12, p1967
Academic Journal
Purpose: To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1-2 cm. Materials and methods: Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed. Results: The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C ( p = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min ( p = 0.082)], fluoroscopic time [175.6 vs. 31.8 min ( p = 0.004)] and hospital stay [3.7 vs. 1.3 days ( p = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% ( p < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C ( p < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively. Conclusions: RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay. ISRCTN 55546280.


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