Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1988 Jul 23;297(6643):253–258. doi: 10.1136/bmj.297.6643.253

Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

N Mays 1, S Challah 1, S Patel 1, E Palfrey 1, R Creeser 1, P Vadera 1, P Burney 1
PMCID: PMC1833939  PMID: 3416143

Abstract

STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14%(23/162) who had nephrolithotomy; and 64%(94/146) of readmissions after lithotripsy were for complications compared with 30%(7/23) of readmissions after nephrolithotomy. CONCLUSIONS: Nephrolithotomy may be preferable to lithotripsy for treating renal stones and it may not be wise to invest heavily in lithotripsy facilities.

Full text

PDF
253

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baumgartner B. R., Dickey K. W., Ambrose S. S., Walton K. N., Nelson R. C., Bernardino M. E. Kidney changes after extracorporeal shock wave lithotripsy: appearance on MR imaging. Radiology. 1987 May;163(2):531–534. doi: 10.1148/radiology.163.2.3562837. [DOI] [PubMed] [Google Scholar]
  2. Blume E. Sound, shock waves shatter kidney stones. JAMA. 1983 May 13;249(18):2434–2435. [PubMed] [Google Scholar]
  3. Challah S., Mays N. B. The randomised controlled trial in the evaluation of new technology: a case study. Br Med J (Clin Res Ed) 1986 Mar 29;292(6524):877–879. doi: 10.1136/bmj.292.6524.877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Charig C. R., Webb D. R., Payne S. R., Wickham J. E. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy. Br Med J (Clin Res Ed) 1986 Mar 29;292(6524):879–882. doi: 10.1136/bmj.292.6524.879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chaussy C., Schmiedt E. Extracorporeal shock wave lithotripsy (ESWL) for kidney stones. An alternative to surgery? Urol Radiol. 1984;6(2):80–87. doi: 10.1007/BF02923707. [DOI] [PubMed] [Google Scholar]
  6. Chaussy C., Schmiedt E. Shock wave treatment for stones in the upper urinary tract. Urol Clin North Am. 1983 Nov;10(4):743–750. [PubMed] [Google Scholar]
  7. Chaussy C., Schüller J., Schmiedt E., Brandl H., Jocham D., Liedl B. Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology. 1984 May;23(5 Spec No):59–66. doi: 10.1016/0090-4295(84)90243-7. [DOI] [PubMed] [Google Scholar]
  8. Das G., Dick J., Bailey M. J., Fletcher M. S., Webb D. R., Kellett M. J., Whitfield H. N., Wickham J. E. Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic. Br Med J (Clin Res Ed) 1987 Oct 10;295(6603):891–893. doi: 10.1136/bmj.295.6603.891. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kaude J. V., Williams C. M., Millner M. R., Scott K. N., Finlayson B. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy. AJR Am J Roentgenol. 1985 Aug;145(2):305–313. doi: 10.2214/ajr.145.2.305. [DOI] [PubMed] [Google Scholar]
  10. Lee W. J., Smith A. D., Cubelli V., Vernace F. M. Percutaneous nephrolithotomy: analysis of 500 consecutive cases. Urol Radiol. 1986;8(2):61–66. doi: 10.1007/BF02924078. [DOI] [PubMed] [Google Scholar]
  11. Lingeman J. E., Newman D., Mertz J. H., Mosbaugh P. G., Steele R. E., Kahnoski R. J., Coury T. A., Woods J. R. Extracorporeal shock wave lithotripsy: the Methodist Hospital of Indiana experience. J Urol. 1986 Jun;135(6):1134–1137. doi: 10.1016/s0022-5347(17)46016-2. [DOI] [PubMed] [Google Scholar]
  12. Miller K., Fuchs G., Rassweiler J., Eisenberger F. Financial analysis, personnel planning and organizational requirements for the installation of a kidney lithotripter in a urologic department. Eur Urol. 1984;10(4):217–221. doi: 10.1159/000463795. [DOI] [PubMed] [Google Scholar]
  13. Newman R. C., Bezirdjian L., Steinbock G., Finlayson B. Complications of extracorporeal shock wave lithotripsy: prevention and treatment. Semin Urol. 1986 Aug;4(3):170–174. [PubMed] [Google Scholar]
  14. Palfrey E. L., Bultitude M. I., Challah S., Pemberton J., Shuttleworth K. E. Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy. Br J Urol. 1986 Dec;58(6):573–577. doi: 10.1111/j.1464-410x.1986.tb05887.x. [DOI] [PubMed] [Google Scholar]
  15. Riehle R. A., Jr, Fair W. R., Vaughan E. D., Jr Extracorporeal shock-wave lithotripsy for upper urinary tract calculi. One year's experience at a single center. JAMA. 1986 Apr 18;255(15):2043–2048. [PubMed] [Google Scholar]
  16. Sleight M. W., Wickham J. E. Long-term follow-up 100 cases of renal calculi. Br J Urol. 1977;49(7):601–604. doi: 10.1111/j.1464-410x.1977.tb04538.x. [DOI] [PubMed] [Google Scholar]
  17. Stone O. J. Cosmetic reactions to artificial fingernails. West J Med. 1987 Sep;147(3):295–295. [PMC free article] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES