Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Renal Stone Clearance Rates of PCNL and ESWL

Dr. Muhammad Haroon Ghous Dr. Ali Hassan Dr. Sikander Afzal,
Chair; Division of Urology, UCM Senior Registrar, UCM Associate Dean, Admin; UCM
University of Lahore University of Lahore University of Lahore

Abstract I. INTRODUCTION

 Objective: In worldwide renal stone is a significant health

To compare the rate of stone free after one week in problem. In North America and Europe renal stone affects
patients of renal stones (1-2 cm) by PCNL the population around 8%-15%.1 In Pakistan renal stone is
(Percutaneous Nephrolithotomy) versus ESWL common disease in urological problems as Pakistan situated
(extracorporeal shock wave lithotripsy) geographically in stone diseases distribution. The patients
mean age is 40 years in Pakistan that affected by renal
 Methodology: stone.2 The most important treatment for renal stone is
This Randomized Controlled Trial was conducted surgery and for complicated renal stones still open surgery
at Urology Department, Galway University Hospital, performed.3 The main objective or target for surgery is
Galway, Republic of Ireland from 1st January 2018 to stone free patient as bacteria present in stone and it leads
31st December 2018. Total 104 patients were included. towards stone growth.4 Stone site e.g. ureter or kidney and
The patients were divided into two groups. Group-A (52 dimensions are the key parameters in the choosing of
cases) with ESWL, while Group-B (52 cases) with treatment.5
PCNL. The patients were briefed about both the
techniques, their likely consequences in terms of With the passage of time advances happened in the
advantages and disadvantages. The procedure was field of medicine also in stone management endoscopic that
considered successful if the patient will be stone free. allows to treat with kidney stone easily than invasive
Data were entered and analyzed in statistical software techniques, which also increased rate of success than
Statistical Package for Social Sciences (SPSS) v25.0. treatment morbidity in old methods. These includes SWL
Data were stratified for age, gender and socio-economic (lithotripsy shock wave), URS (ureterorenoscopic) and
status to address the effect modifiers. A p-value ≤0.05 PCNL (nephrolithotomy percutaneous).6 The PCNL
was considered as a level of significance. endoscopic procedure is suitable for calculi stone of greater
than 10 mm and for small size calculi SWL is suitable but
 Results: SWL have significantly low clearance rate instead of many
One hundred and four patients fulfilling the sittings.7,8
inclusion criteria were included in this study. Patients
were divided in two groups i.e. Group-A (ESWL) and The patients feel discomfort in SWL due to its
Group-B (PCNL). The mean age of patients in group-A noninvasive nature.9 With surgeon increasing experience,
was 43.5±12.5 years and in group-B was 45.8±15.3 instruments miniaturization better imaging the PCNL
years. In group-A, stone free rate was 39(75.0%), while become free from complications and minimal invasive.8,10
48(92.3%) in group-B with a p-value of 0.017, which is In a study the clearance of stone by PCNL is higher 95.3%
statistically significant. when compared with ESWL in which it was 79.2%. 11 In
other study it was by PCNL was 97.4% and by ESWL it
 Conclusion: was 67.9%.12
There is a difference of stone free rate at one week
after extracorporeal shock wave lithotripsy (ESWL) Presently in our country no published study available
versus Percutaneous Nephrolithotomy (PCNL) for renal on this topic due to lack of research sources and conflict
stones of 1-2 cm with international literature. Therefore, the purpose of
current study is to differentiate which treatment is a better
Keywords:- Kidney Stone, ESWL, PCNL. option for the renal stone; PCNL or ESWL. The results of
this study will be helpful for the management of renal stone
patients with best technique. So the best technique is
adopted in our current settings on the basis of these results.

 Objective:
To compare the rate of stone free after one week in
patients of renal stones (1-2 cm) by PCNL (Percutaneous
Nephrolithotomy) versus ESWL (extracorporeal shock
wave lithotripsy)

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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
II. METHODOLOGY patients was kept post-operatively. When necessary DJ
stent was kept. If DJ stent was not used then catheter
The trial was Randomized Controlled that conducted ureteric kept. For fragmentation pneumatic lithoclast used
at Urology Department, Galway University Hospital, and tripronge forceps or alligator used for fragments
Galway, Republic of Ireland from 1st January 2018 to 31st retrieval. All the patients after operation on second day had
December 2018. Total 104 patients were included. The X-ray KUB. If there was no stone then this procedure
inclusion criteria was Age 18-70 years, Patients of both sex consider to be think safe and successful.
(male or female) and Patients with stone size upto 1-2cm.
The exclusion criteria was Culture positive (urine c/s> 105 SPSS v25.0 was used for the analysis of data
c/c), Patient having previous history of endoscopic surgery, statistically. For categorical variables like genders the
Rental stone (radio opaque shadow in rental area on X-ray percentages and frequency was calculated, socio-economic
KUB), Pregnancy and Uncontrolled coagulopathy status and stone free status. Mean and SD were computed
(INR>1.5). Renal calculi was defined as radio opaque for quantitative measurements like age and stone size. Data
shadow seen on X-ray KUB. Stone of size 1-2cm was were stratified for age, gender and socio-economic status to
included. Stone free rate was defined as number of patients address the effect modifiers. The p value of ≤0.05 was
that would be Stone free (absence of radio opaque shadow considered as a level of significance.
on x ray KUB) at first post operative week.
III. RESULTS
By using proforma the demographic information was
collected. The patients were divided into two groups. One hundred and four patients fulfilling the inclusion
Group-A (52 cases) with ESWL, while Group-B (52 cases) criteria were included in this study. Patients were divided in
with PCNL. The patients were briefed about both the two groups i.e. Group-A (ESWL) and Group-B (PCNL). In
techniques, their likely consequences in terms of group-A, there were 36(69.2%) were males and 16(30.8%)
advantages and disadvantages. ESWL was performed by were females. In group-B, 38(73.1%) were males and
using the electromagnetic generator as an energy source. 14(26.9%) were females.
Stone was targeted with the help of fluoroscopy and 3000
shock waves given with rate of 60 – 90 waves per minute. The mean age of patients in group-A was 43.5±12.5
years and in group-B was 45.8±15.3 years. In group-A,
The level of shock wave energy was progressively there were 12(23.1%) in 18-30 years age group, while
stepped up till satisfactory stone fragmentation within the 18(34.6%) and 22(42.3%) were in 31-45 years and >45
comfort of patients. All patients were previously well years age groups respectively.
hydrated to improve the efficacy of ESWL. Fluoroscopy
was used time to time during the procedure to see the In group-B, there were 11(21.2%) in 18-30 years age
cleavage of stone and re-targeting if required. The group, while 18(34.6%) and 23(44.2%) were in 31-45 years
procedure was done as a daycare procedure. All patients and >45 years age groups respectively. According to socio-
were treated in supine position and received analgesia economic status (SES), in group-A, 17(32.7%) had low
according to their body weight. SES, while 19(36.5%) and 16(30.8%) had middle and high
SES respectively, while in group-B, 11(21.2%) had low
All patients were advised an oral analgesic and SES, while 28(53.8%) and 13(25.0%) had middle and high
selective alpha-1 D adrenergic inhibitor agents on discharge SES respectively.
to improve stone clearance. Under fluoroscopy, regional
anesthesia control PCNL performed in cases. 22, 26 and 24 In group-A, stone free rate was 39(75.0%), while
Fr Amplatz sheath and alken dilators as necessary was 48(92.3%) in group-B with a p-value of 0.017, which is
used. For twenty four hours 14 or 12 Fr cathater in all the statistically significant.

Groups
Gender Total p-value
Group-A (ESWL) Group-B (PCNL)

36 38 74
Male
69.2% 73.1% 71.2%

16 14 30
Female 0.665
30.8% 26.9% 28.8%

52 52 104
Total
100.0% 100.0% 100.0%
Table 1:- Comparison of Gender Distribution between Groups

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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Groups

Age groups Total p-value

Group-A (ESWL) Group-B (PCNL)

12 11 23
18-30 years
23.1% 21.2% 22.1%

18 18 36
31-45 years
34.6% 34.6% 34.6%
0.968
22 23 45
>45 years
42.3% 44.2% 43.3%

52 52 104
Total
100.0% 100.0% 100.0%
Table 2:- Comparison of Age Distribution between Groups

Groups
Socio-Economic Status (SES) Total p-value
Group-A (ESWL) Group-B (PCNL)

17 11 28
Low (<20,000/month)
32.7% 21.2% 26.9%
19 28 47
Middle (20-50,000/month)
36.5% 53.8% 45.2%
0.190
16 13 29
High (>50,000/month)
30.8% 25.0% 27.9%
52 52 104
Total
100.0% 100.0% 100.0%
Table 3:- Comparison of Socio-Economic Status between Groups

Groups

Stone Free Total p-value

Group-A (ESWL) Group-B (PCNL)

39 48 87
Yes
75.0% 92.3% 83.7%

13 4 17
No 0.017
25.0% 7.7% 16.3%

52 52 104
Total
100.0% 100.0% 100.0%
Table 4:- Comparison of Stone Free Rate between Groups

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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Groups
Gender Stone Free Total p-value
Group-A (ESWL) Group-B (PCNL)

26 34 60
Yes
72.2% 89.5% 81.1%
10 4 14
Male No 0.058
27.8% 10.5% 18.9%
36 38 74
Total
100.0% 100.0% 100.0%
13 14 27
Yes
81.3% 100.0% 90.0%
3 0 3
Female No 0.088
18.8% 0.0% 10.0%
16 14 30
Total
100.0% 100.0% 100.0%
Table 5:- Stratification of Stone Free Rate With Respect to Gender between Groups

Groups
Age groups Stone Free Total p-value
Group-A (ESWL) Group-B (PCNL)

8 11 19
Yes
66.7% 100.0% 82.6%
4 0 4
18-30 years No 0.035
33.3% 0.0% 17.4%
12 11 23
Total
100.0% 100.0% 100.0%
16 17 33
Yes
88.9% 94.4% 91.7%
2 1 3 0.543
31-45 years No
11.1% 5.6% 8.3%
18 18 36
Total
100.0% 100.0% 100.0%
15 20 35
Yes
68.2% 87.0% 77.8%
7 3 10 0.130
>45 years No
31.8% 13.0% 22.2%
22 23 45
Total
100.0% 100.0% 100.0%
Table 6:- Stratification of Stone Free Rate With Respect To Gender between Groups

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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. DISCUSSION REFERENCES

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