Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones

Extracorporeal shock wave lithotripsy (ESWL) appears to be less effective for lower pole kidney stones than percutaneous nephrolithotomy (PCNL). There seems to be no difference between ESWL and retrograde intrarenal surgery (RIRS).

A Cochrane review included 3 studies with a total of 214 subjects. Results could not be pooled. 2 studies compared ESWL to PCNL. The success rate at 3 months for lower pole kidney stones was statistically higher for PCNL (RR 0.39, 95% CI 0.27 to 0.56; 1 study, n=107). Re-treatment (RR 1.81, 95% CI 0.66 to 4.99; 1 study, n=122) and using auxiliary procedures (RR 9.06, 95% CI 1.20 to 68.64; 1 study, n=122) after PCNL were less compared to ESWL, although the results for re-treatment were not statistically significant. The efficiency quotient (EQ) in PCNL was higher than ESWL (86% vs. 28%, respectively). Hospital stay (MD -3.30 days, 95% CI -5.45 to -1.15; 1 study, n=49), duration of treatment (MD -36.00 minutes, 95% CI -54.10 to -17.90; 1 study, n=49) and complications were less for ESWL.

One study compared ESWL versus RIRS for lower pole kidney stones. The success rate was not significantly different at the end of the third month (RR 0.91, 95% CI 0.64 to 1.30; 1 study, n=58).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).

Ədəbiyyat

1. Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2009;(4):CD007044.