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Tubeless Percutaneous Nephrolithotomy (TPCNL) is Superior to Ureterorenoscopy (URS) and Shockwave lithotripsy (SWL) for 0.5 to 1.5cm Lower Pole Stones (LPS)
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Tubeless Percutaneous Nephrolithotomy (TPCNL) is Superior to Ureterorenoscopy (URS) and Shockwave lithotripsy (SWL) for 0.5 to 1.5cm Lower Pole Stones (LPS)
Daniel M. Kaplon, MD, George Haleblian, MD, Gyan Pareek, MD.
The Warren Alpert Medical School of Brown University, 02903, RI, USA.
Background: AUA guidelines for treatment and manamgment of LPS suggest URS and SWL as primary treatment modalities for stones <1.5 cm. Recent evidence suggests efficacy of SWL has diminished with newer generation lithotripters and access to lower pole calicies can be challenging with URS. We evaluate the efficacy of front line TPCNL for treatment of LPS conventionally relegated to SWL or URS.
Methods:Thirty-two consecutive patients from Stone Therapy Center of New England (STONE) undergoing treatment of 0.5 to 1.5 cm lower pole calculi were reviewed. Of these 12 underwent TPCNL, 10 URS and 10 SWL. Demographic data, stone size, Hounsfield units (HU), and skin to stone distance (SSD) were measured in each cohort. The stone free (SF) status (no residual calculi) of patients was determined by post-treatment imaging (ct scan or KUB) at 6 weeks. The number of auxillary procedures to clear calculi as well as the number of complications in each group were tabulated. Statistical analysis was performed to evaluate for significant difference in SF rates and the number of auxillary procedures.
Results: Between the three chorts, there was no statistically significant difference in patient demographics, stone size, HU and SSD. Stone-free rates were significantly greater in the TPCNL group (100%) than the URS (80%) and SWL Group (30%). (P<0.05). Auxillary procedures in the SWL cohort (n = 7) was significantly more than in the URS (n = 2) and TPCNL (n = 0) groups. There were no major complications were observed in any of the treatment groups.
Conclusions: TPCNL has a high success rate in patients with LPS and may be offered as first line treatment. It can be performed with no additional morbidity when compared to traditional first line therapies (SWL or URS) and may obviate the need for auxillary procedures.
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