Objectives: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1–2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. Patients and Methods: Between 2007 and 2011, 56 patients with lower calyceal stones 1–2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. Results: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. Conclusion: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1–2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.

Keywords:
Lower pole anatomy, Percutaneous nephrolithotomy, Shockwave lithotripsy, Ureterorenoscopy
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2012
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