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Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones.

Knoll T, Buchholz N, Wendt-Nordahl G - Arab J Urol (2012)

Bottom Line: This seems to result from a lower rate of fragment passage, due to anatomical factors.Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL.Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Germany.

ABSTRACT

Objectives: To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors.

Methods: Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990-2011).

Results: Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones.

Conclusions: Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered.

No MeSH data available.


Related in: MedlinePlus

A proposed treatment algorithm for lower-pole stones according to the 2012 update of the EAU Guideline on Urolithiasis [29].
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Related In: Results  -  Collection

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f0005: A proposed treatment algorithm for lower-pole stones according to the 2012 update of the EAU Guideline on Urolithiasis [29].

Mentions: ESWL, especially in an anaesthesia-free outpatient setting, remains the first-line treatment option for small lower-pole stones [56]. It offers an acceptable SFR, few complications and a low recurrence rate [11,24]. According to the updated EAU Guidelines (Fig. 1) [29] the treatment outcome for stones of 1–2 cm depends on the predictive factors (Box 1). If the success of ESWL is unlikely the recommended approach is endourology, either retrograde fURS or PCNL. This is a paradigm shift for the value of fURS. While earlier reports failed to show the superiority of fURS over ESWL, the new guideline now considers that current experience gives a different impression [7,57]. In experienced hands fURS is an excellent option to completely remove stones after one session. Furthermore, there are situations where ESWL is either contraindicated or has limited efficacy, e.g. uncorrected bleeding diathesis (although ESWL with low-dose salicylate might be safe [58]), obesity, or complicated anatomy [59]. PCNL is recommended for larger stones of >1.5 cm [23]. It is the most effective treatment but also the most invasive, with a need for general anaesthesia, few but possibly severe complications, and a potentially longer convalescence than after ESWL and fURS [57]. The lower pole is the ideal indication for PCNL because of the easy access and a low complication rate.


Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones.

Knoll T, Buchholz N, Wendt-Nordahl G - Arab J Urol (2012)

A proposed treatment algorithm for lower-pole stones according to the 2012 update of the EAU Guideline on Urolithiasis [29].
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442916&req=5

f0005: A proposed treatment algorithm for lower-pole stones according to the 2012 update of the EAU Guideline on Urolithiasis [29].
Mentions: ESWL, especially in an anaesthesia-free outpatient setting, remains the first-line treatment option for small lower-pole stones [56]. It offers an acceptable SFR, few complications and a low recurrence rate [11,24]. According to the updated EAU Guidelines (Fig. 1) [29] the treatment outcome for stones of 1–2 cm depends on the predictive factors (Box 1). If the success of ESWL is unlikely the recommended approach is endourology, either retrograde fURS or PCNL. This is a paradigm shift for the value of fURS. While earlier reports failed to show the superiority of fURS over ESWL, the new guideline now considers that current experience gives a different impression [7,57]. In experienced hands fURS is an excellent option to completely remove stones after one session. Furthermore, there are situations where ESWL is either contraindicated or has limited efficacy, e.g. uncorrected bleeding diathesis (although ESWL with low-dose salicylate might be safe [58]), obesity, or complicated anatomy [59]. PCNL is recommended for larger stones of >1.5 cm [23]. It is the most effective treatment but also the most invasive, with a need for general anaesthesia, few but possibly severe complications, and a potentially longer convalescence than after ESWL and fURS [57]. The lower pole is the ideal indication for PCNL because of the easy access and a low complication rate.

Bottom Line: This seems to result from a lower rate of fragment passage, due to anatomical factors.Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL.Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Germany.

ABSTRACT

Objectives: To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors.

Methods: Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990-2011).

Results: Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones.

Conclusions: Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered.

No MeSH data available.


Related in: MedlinePlus