Laser lithotripsy versus eswl for lower calyceal renal stones

INTRODUCTION AND OBJECTIVES: Urolithiasis, especially lower calyceal (LC) stones, is a common medical problem. Its prevalence is around 2% to 3 % in general population. With advances of endourologic and laser technology, flexible ureterorenoscopy (FURS) and laser lithotripsy (LL) are considered the second line therapy in ESWL-resistent LC stones. This study aimed to assess safety, efficacy and outcome of FURS and holmium:YAG LL comparing its results to ESWL in LC stones. METHODS: A prospective randomized study was done from May 2010 to May 2012. It included patients with radiopaque unilateral, single or multiple, LC = 20mm. Patients were divided into 2 groups. In Group I, patients underwent FURS and LL using 365 >m laser fiber. In Group II, patients underwent ESWL. Patients were followed for 3 months by KUB to assess stone-free status defined as no fragments or fragment = 3mm. In each group, multiple parameters (age, sex, stone size and number, and LC anatomy) were examined to assess impact on stone-free status. Additionally stone-free status and complications were compared in both groups. RESULTS: 60 patients were included in the study. In Group I (N=30), mean age was 44.2 years and mean stone size was 11.5mm. 26 patients (86.7%) had single stone and 4 patients (13.3%) had multiple stones. Stone free status was achieved in 29 patients (96.7%). Complication rate was 16.7%. Age, sex, stone size and number, and LC anatomy did not correlate with stone-free status in Group I. In Group II (N=30), mean age was 35.5 years and mean stone size was 11.3mm. 28 patients (93.3%) had single stone and 2 patients (6.7%) had multiple stones. Stone-free status was achieved in 17 patients (56.7%). Complication rate was 23.3%. Stone size (<10mm) only correlated with stone-free status in Group II. FURS and LL achieved significantly better stone-free rates compared to ESWL (96.7% vs 56.7%, p= 0.001), with no difference in complication rate between both groups (16.7% vs 23.3%, p= 0.5). CONCLUSIONS: Both FURS with LL and ESWL are considered safe in treating LC stones less than 20mm with minimal complication rates. However, FURS with LL achieved significantly better stone-free rates. Stone size could predict stone-free status in ESWL.