|
|||||
|
|
Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less |
|
| Authors: | Pearle Margaret S Lingeman James E Leveillee Raymond Kuo Ramsay Preminger Glenn M Nadler Robert B Macaluso Joseph Monga Manoj Kumar Udaya Dushinski John Albala David M Wolf J Stuart Assimos Dean Fabrizio Michael Munch Larry C Nakada Stephen Y Auge Brian Honey John Ogan Kenneth Pattaras John McDougall Elspeth M Averch Timothy D Turk Thomas Pietrow Paul Watkins Stephanie |
| Institution: | aDepartment of Urology, University of Texas Southwestern Medical Center (MSP), Dallas, Texas, Institute for Kidney Stone Disease, Methodist Hospital (JEL, LCM, SW), Indianapolis, Indiana, Department of Urology, University of Miami (RL), Miami, Florida, Departments of Urology, Thomas Jefferson University Hospital (RK), Philadelphia and University of Pittsburgh (TDA), Pittsburgh, Pennsylvania, Division of Urology, Duke University Medical Center (GMP, DMA), Durham and Department of Urology, Wake Forest University Health Sciences Center (DA), Winston-Salem, North Carolina, Departments of Urology, Northwestern University Medical School (RBN) and Loyola University Medical Center (TT), Chicago, Illinois, Urologic Institute of New Orleans/Meadowcrest Hospital 5 (JM), New Orleans, Louisiana, Department of Urology, University of Minnesota (MM), Minneapolis, Minnesota, Department of Urology, University of Arkansas for Medical Sciences (UK), Little Rock, Arkansas, Rockyview Hospital, Calgary Health Region (JD), Calgary, Alberta, and Division of Urology, St. Michael’s Hospital, University of Toronto (JH), Toronto, Ontario, Canada, Department of Urology, University of Michigan (JSW), Ann Arbor, Michigan, Eastern Virginia Medical School and Institute for Kidney Stone Disease, Methodist Hospital (MF), Norfolk, Virginia, Division of Urology, University of Wisconsin-Madison Medical School (SYN), Madison, Wisconsin, Departments of Urology, Naval Medical Center (BA), San Diego and University of California-Irvine (EMM), Irvine, California, Department of Urology, Emory University School of Medicine (KO, JP), Atlanta, Georgia, and Section of Surgery, Kansas University Medical Center (PP), Kansas City, Kansas |
| Abstract: | PURPOSE: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial. MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome parameters were length of stay, complication rates, need for secondary procedures and patient derived quality of life measures. RESULTS: A total of 67 patients randomized to SWL (32) or URS (35) completed treatment. The 2 groups were comparable with respect to age, sex, body mass index, side treated and stone surface area. Operative time was significantly shorter for SWL than URS (66 vs 90 minutes). At 3 months of followup 26 and 32 patients who underwent SWL and URS had radiographic followup that demonstrated a stone-free rate of 35% and 50%, respectively (p not significant). Intraoperative complications occurred in 1 SWL case (unable to target stone) and in 7 URS cases (failed access in 5 and perforation in 2), while postoperative complications occurred in 7 SWL and 7 URS cases. Patient derived quality of life measures favored SWL. CONCLUSIONS: This study failed to demonstrate a statistically significant difference in stone-free rates between SWL and URS for the treatment of small lower pole renal calculi. However, SWL was associated with greater patient acceptance and shorter convalescence. |
| Keywords: | Key Words:: kidney kidney calculi lithotripsy ureteroscopy |
| 本文献已被 ScienceDirect PubMed 等数据库收录！ | |