Background: The treatment of renal stones remains a challenge for urologist. The size usually defined the optimal procedure. The introduction of new non-invasive modalities adds to the challenge.
The Aim of the work: The current work aimed to compare between efficacy and safety of retrograde intrarenal surgery [RIRS] and extracorporeal shock wave lithotripsy [ESWL] in the treatment of lower calyceal favorable renal stones up to 20 mm.
Patients and Methods: This prospective randomized comparative study included 90 subjects with lower pole stones less than 20 mm. they were randomized into 2 equal groups: Group [A] underwent RIRS using disposable flexible ureteroscope. Group B included 45 patients treated by ESWL. All were submitted to preoperative workup consisting of complete general and urological evaluation, laboratory investigation and radiological investigations. The primary outcome was the stone free rate at the end of the third postoperative month. The secondary outcomes included postoperative complications, need for retreatment, mortality, the cost and satisfaction.
Results: Both groups were comparable regarding patient characteristics and preoperative data. The operative time was significantly shorter in ESWL than RIRS groups [51.02±7.08 vs 60.51±10.47 minutes]. Double-J was higher among the RIRS group [43 vs 2 patients]. The stone-free rate [SFR] was significantly higher among RIRS than ESWL [84.4% vs 62.2%]. The hospital stay was shorter, and stenting was significantly lower among ESWL than RIRS group. Fever, hematuria, and mucosal injury were lower, but perinephric hematoma, renal colic and ecchymosis were significantly higher in ESWL group. Voiding symptoms was significantly higher in the RIRS group. The need for retreatment was significantly higher in ESWL group, but the cost was significantly lower, and no mortality was reported in the study
Conclusion: Retrograde intrarenal surgery has a better stone free rate than ESWL, with comparable postoperative rate of complications. But its higher cost is a limiting step for its use with readily available noninvasive ESWL treatment.