The evaluations of ESWL, RIRS and m-PCNL treatments in kidney stones smaller than two centimeters

Objective: The aim of the current study was to compare the outcome of minimal invasive treatment (RIRS, m-PCNL) with the ESWL, Micro-Percutaneous Nephrolithotomy (m-PCNL), and Retrograde intrarenal surgery (RIRS) in patients with renal calculi less than two centimeters in size. Methods: Preoperative renal ureter-bladder (KUB) film and computed tomography (CT) used to imaging stone size and localization in all patients. Ninety consecutive patients were randomized equally to three groups. We evaluated age, gender, stone size, length of hospitalization, stone-free rates, X-ray duration that patients were exposed during the processes, general anesthesia time, Visual Analogue Scale values, Modified Clavien Complication Scale scores after RIRS, mPCNL, and ESWL on renal stones smaller than 2 cm. Results: At the end of the first month, stone-free rate for the lower calyx stones was 33.3% (3 patients out of 10) in ESWL, 83.3% (10 patients out of 12) in RIRS, and 90.9% (10 patients out of 11) in m-PCNL. ESWL's success in the lower-calyx stones was found to be low. Our rates for the stones in renal pelvis, middle, and upper calyx were % 85.7 (18 patients out of 21) in ESWL, % 94.4 (17 patients out of 18) in RIRS and % 94.7 (18 patients out of 19) in m-PCNL. No difference was observed in the duration of hospitalization among patients who underwent RIRS and m-PCNL. The VAS scores in ESWL group were higher than other groups. There were no significant differences for fluoroscopy time between the groups. Decrease in hemoglobin values before and after the procedure were found to be significant in m-PCNL group (p<0.05). Conclusions: We compared three minimal invasive treatments for less than 2 cm renal stones; m-PCNL and RIRS methods were found to be more effective than ESWL, especially aspects of the stone free rates.