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

Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M

Published Online:

October 7, 2009

Stones in the urinary tract are a common medical problem. Fifty per cent of patients with previous urinary stones have a recurrence within 10 years. Kidney stones can cause pain, blood in the urine, infection, decreased kidney function and kidney failure. The treatment is to remove the stones from kidney. Extracorporeal shock wave lithotripsy (ESWL) disintegrates stones using shock waves and is a minimally invasive technique. Other minimally invasive methods (percutaneous nephrolithotomy (PCNL)) and retrograde intrarenal surgery (RIRS)) are widely used for kidney stones management because ESWL had limited success rate. This review aimed to compare the effectiveness and complications between ESWL and stones removing using the nephroscopy through the skin at kidney level (PCNL) or ureteroscope through the bladder and ureter to the kidney (RIRS). Three small randomised studies (214 patients) were included. Two studies compared ESWL with PCNL and one study compared ESWL with RIRS. Patients with lower pole kidney stones who undergo PCNL have a higher success rate than ESWL whereas RIRS was not significantly different from ESWL. However, ESWL patients spent less time in hospital and the duration of treatment was shorter.

Abstract (click to read)

Background:

Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied.

Objectives:

To evaluate the effectiveness and complications of ESWL compared with PCNL or RIRS for managing kidney stones.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE, EMBASE and reference lists of articles without language restriction.

Selection criteria:

Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management.

Data collection and analysis:

Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results:

Three studies (214 patients) were included, however results could not be pooled. Two RCTs compared ESWL to PCNL. The success rate at three months for lower pole kidney stones was statistically higher for PCNL (RR 0.39, 95% CI 0.27 to 0.56). Re-treatment (RR 1.81, 95% CI 0.66 to 4.99) and using auxiliary procedures (RR 9.06, 95% CI 1.20 to 68.64) after PCNL were less compared to ESWL. The efficiency quotient (EQ) in PCNL was higher than ESWL. Hospital stay (MD -3.30 days, 95% CI -5.45 to -1.15), duration of treatment (MD -36.00 minutes, 95% CI -54.10 to -17.90) and complications were less for ESWL. One RCT 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).

Authors' conclusions:

Results from three small studies, with low methodological quality, indicated ESWL is less effective for lower pole kidney stones than PCNL but not significantly different from RIRS. Hospital stay and duration of treatment was less with ESWL. More RCTs are required to investigate the effectiveness and complications of ESWL for kidney stones compared to PCNL or RIRS.

This record should be cited as:

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 of Systematic Reviews 2009, Issue 4. Art. No.: CD007044. DOI: 10.1002/14651858.CD007044.pub2

Assessed as up to date:

November 27, 2008

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > Urology > Stones (renal & ureteric)

Urology > Stones (renal & ureteric)

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Independent high-quality evidence for health care decision making

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

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