RETROGRADE URETEROSCOPIC LITHOTRIPSY PLUS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR TREATMENT OF RELATIVELY LARGE RENAL PELVIS STONES

Background and Renal stones are usually treated through ESWL or through skin nephostomy. This study was conducted to compare between efficacy and safety of retrograde ureteroscopic lithotripsy with pneumatic lithotriptor plus extracorporeal shock wave lithotripsy versus extracorporeal shock wave lithotripsy alone for treatment of 2 to 3 cm renal pelvis stones. Methods and Materials: This randomized clinical trial was conducted on the population of patients with 2-3 cm renal pelvis stones admitted to the Imam Reza Hospital clinic for radiological patients from Shahrivar 1382 to Shahrivar 1384 (2004-2005). Sampling procedure included patients with such a diagnosis who had indications for the suggested treatment procedure. The final sample amounted to 55 patients. We divided our patients into two groups. In group 1, (22 patients) first we attempted to break the nidus of the stone with retrograde ureteroscopic pneumatic lithotripsy, and then we inserted a double J stent and after 2 to 4 weeks, send them for extracorporeal shock wave lithotripsy. Group II patients (33 patients), after cystoscopic insertion of double J stent, underwent extracorporeal shock wave lithotripsy alone. Stone free rate and complication rate after three months were recorded. The patient's mean age in two groups were 28.7 and 29.4 years respectively. There was no statistical differences between the age and sex of the two groups. In group 1, in two patients we could not reach to stone ureteroscopically. Stone free rate in group 1, was 77% (17/22). In group II, after two sessions of extracorporeal lithotripsy, stone free rate was just 45% (15/33). There was no significant complication in two groups. The present study demonstrated that ureteroscopy and breaking the stone nidus with pneumatic lithotripter before extracorporeal shock wave lithotripsy is an acceptable treatment modality for relatively large renal pelvis stone.