Evaluation of different modalities for surgical management of renal stones

ABSTRACT

There is no single method suitable for the removal of all renal stones. The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. The aim of the work is to evaluate different modalities as extracorporeal shock wave lithotripsy [ESWL], percutaneous nephrolithotomy [PNL] and open stone surgery [OSS] in the management of renal stones in patients attending our department in one year. This study was conducted on 200 patients with renal calculi. The patients were divided into three groups group A [100 patients] underwent ESWL, group B [50 patients] had PNL and group C [50 patients] had OSS. They were completely evaluated by histor, physical examination, laboratory and radiological investigation. Patients were evaluated postoperatively by KUB, US and urinalysis at 1 day, 2 week up to 3 months. Comparing the results in the three groups revealed that the total stone free rate [SFR] in them is nearly equal 90%, 88% and 88% in group A, B and C respectively. On the other hand comparing the results in the three groups in relation to the stone characteristics [burden, number and fresh or recurrent] revealed that the SFR in them is nearly equal in single and small burden stone either fresh or recurrent. While with multiple and large stone burden [> 3 cm] PNL gives the best results [72.2 - 87.5%] especially with recurrent cases as a monotherapy, followed by open surgery [66.6- 80%] especially with fresh cases, then ESWL as it gives the least SFR [33.3-60%]. Stones less than 1 cm, ESWL is usually the primary approach. For stones between 1 - 2 cm, ESWL is still the first-line treatment unless factors of stone composition, location, or renal anatomy shift the balance toward more invasive but definitive treatment modalities [PNL or OSS]. Stones > 2 cm should primarily be treated by PNL, unless specific indications for OSS are present. Stones >3cm, multiple or staghorn better managed by sandwich technique [PNL and ESWL]