Lower pole I

A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results

D. M. Albala, D. G. Assimos, R. V. Clayman, J. D. Denstedt, M. Grasso, J. Gutierrez-Aceves, R. I. Kahn, R. J. Leveillee, J. E. Lingeman, Jr Macaluso J.N., L. C. Munch, S. Y. Nakada, R. C. Newman, Margaret S Pearle, G. M. Preminger, J. Teichman, J. R. Woods

Research output: Contribution to journalArticle

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Abstract

Purpose: The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. Materials and Methods: A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Results: Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 rum. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Conclusions: Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.

Original languageEnglish (US)
Pages (from-to)2072-2080
Number of pages9
JournalJournal of Urology
Volume166
Issue number6
StatePublished - 2001

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Nephrolithiasis
Lithotripsy
Kidney Calculi
Calculi
Morbidity
Therapeutics
Treatment Failure
Multicenter Studies
Randomized Controlled Trials

Keywords

  • Clinical trials
  • Kidney
  • Laser
  • Lithotripsy

ASJC Scopus subject areas

  • Urology

Cite this

Albala, D. M., Assimos, D. G., Clayman, R. V., Denstedt, J. D., Grasso, M., Gutierrez-Aceves, J., ... Woods, J. R. (2001). Lower pole I: A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results. Journal of Urology, 166(6), 2072-2080.

Lower pole I : A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results. / Albala, D. M.; Assimos, D. G.; Clayman, R. V.; Denstedt, J. D.; Grasso, M.; Gutierrez-Aceves, J.; Kahn, R. I.; Leveillee, R. J.; Lingeman, J. E.; Macaluso J.N., Jr; Munch, L. C.; Nakada, S. Y.; Newman, R. C.; Pearle, Margaret S; Preminger, G. M.; Teichman, J.; Woods, J. R.

In: Journal of Urology, Vol. 166, No. 6, 2001, p. 2072-2080.

Research output: Contribution to journalArticle

Albala, DM, Assimos, DG, Clayman, RV, Denstedt, JD, Grasso, M, Gutierrez-Aceves, J, Kahn, RI, Leveillee, RJ, Lingeman, JE, Macaluso J.N., J, Munch, LC, Nakada, SY, Newman, RC, Pearle, MS, Preminger, GM, Teichman, J & Woods, JR 2001, 'Lower pole I: A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results', Journal of Urology, vol. 166, no. 6, pp. 2072-2080.
Albala, D. M. ; Assimos, D. G. ; Clayman, R. V. ; Denstedt, J. D. ; Grasso, M. ; Gutierrez-Aceves, J. ; Kahn, R. I. ; Leveillee, R. J. ; Lingeman, J. E. ; Macaluso J.N., Jr ; Munch, L. C. ; Nakada, S. Y. ; Newman, R. C. ; Pearle, Margaret S ; Preminger, G. M. ; Teichman, J. ; Woods, J. R. / Lower pole I : A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results. In: Journal of Urology. 2001 ; Vol. 166, No. 6. pp. 2072-2080.
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abstract = "Purpose: The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. Materials and Methods: A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Results: Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 rum. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88{\%} of treated patients. The 3-month postoperative stone-free rates overall were 95{\%} for percutaneous removal versus 37{\%} lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21{\%}) patients becoming stone-free. Re-treatment was necessary in 10 (16{\%}) lithotripsy and 5 (9{\%}) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13{\%} of lithotripsy and 2{\%} percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22{\%}, shock wave lithotripsy 11{\%}, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Conclusions: Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.",
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T2 - A prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis - Initial results

AU - Albala, D. M.

AU - Assimos, D. G.

AU - Clayman, R. V.

AU - Denstedt, J. D.

AU - Grasso, M.

AU - Gutierrez-Aceves, J.

AU - Kahn, R. I.

AU - Leveillee, R. J.

AU - Lingeman, J. E.

AU - Macaluso J.N., Jr

AU - Munch, L. C.

AU - Nakada, S. Y.

AU - Newman, R. C.

AU - Pearle, Margaret S

AU - Preminger, G. M.

AU - Teichman, J.

AU - Woods, J. R.

PY - 2001

Y1 - 2001

N2 - Purpose: The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. Materials and Methods: A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Results: Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 rum. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Conclusions: Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.

AB - Purpose: The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. Materials and Methods: A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Results: Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 rum. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Conclusions: Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.

KW - Clinical trials

KW - Kidney

KW - Laser

KW - Lithotripsy

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