Extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy, retrograde intrarenal surgery and ureteroscopic lithotripsy in the treatment of renal and proximal ureteric stones: Are they competitive or complimentary?

Abstract

Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopic lithotripsy (URSL) are now standard methods for the treatment of urinary stones. RIRS is newer compared to the others, and has noticeable promise owing to rapid advancements in endoscopic technology. In this article, a nonsystematic review of the literature was performed to select appropriate evidence-based studies that compare these different lines of stone management regarding the success rate, retreatment rate, auxiliary procedures, and operative complications. Meta-analysis of the collected data is performed using MedCalc for Windows, version 12.1.1. The meta-analysis of the selected papers shows that there is significant difference in stone free rate, retreatment rate, and auxiliary procedures between ESWL cases and the cases treated by other lines of stone management in favor of PCNL, RIRS, and URSL. However, there is no significant difference between the different lines of stone treatment with regard to the operative complication. One of the four methods, ESWL, PCNL, RIRS or URSL, can be the best management choice depending on stone size and location. Stones that do not respond to treatment by one method can be effectively treated by an alternative method. The four methods should be available in any well-equipped stone center, but this idea can change with future advances in technology.