الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Between August 2002 and December 2004, 100 patients with lower calyceal renal stones were prospectively randomized to be treated by either ESWL or PCNL in our Urology and Nephrology Centre. Fifty nine males and 41 females were included in this study with mean patient age 47.99.5 years with mean BMI 29.4. The stones were located in 45 right and 55 left renal units. Ninety patients had single stone and 10 patients had multiple stones. Eighty patients had newly formed stones while 20 patients had recurrent stones. Before any intervention, all patients were subjected to history taking, clinical examination, laboratory and radiologic investigations. We used CT to study lower pole anatomical details including IL, IW, LISA, LIPA and calyceal volume. ESWL was performed as an out-patient procedure under sedation using the electromagnetic lithotripter (DoLi S, Dornier med Tech). PCNL was performed as one stage PCNL. Rigid nephroscope was used. The stones were either mechanically removed (28%of cases) or disintegrated at first using lithoclast or ultrasonic lithotripter (72%of cases). Patients were evaluated after treatment by KUB, US and spiral CT. Age of the patient, stone size, lower pole IL, IW and LIPA did not affect the results of ESWL or PCNL. Small LISA and large calyceal volume was associated with lower success rate of ESWL. All failed cases of ESWL had LISA less than 52 mm2. The success rate of ESWL DROPped from 100% to 81.5% in cases with LISA more than 52mm and less than 52mm respectively and from 96.8% to 78.9% in cases with calyceal volume less than 3.5 cm3 and more than 3.5 cm3 respectively. Obesity did not affect the results of PCNL while ESWL was less effective in obese patients. The success rate of ESWL DROPped from 100% in patients with BMI less than 29 to 81% in cases with BMI more than 29. We found that both treatment modalities (ESWL and PCNL) are highly effective for treatment of LPS. The success rate of PCNL (96%) was higher than the success rate of ESWL (90%) but the difference was insignificant (P=0.4). The complications of PCNL (12%) was more than ESWL (4%) but the difference also was insignificant (P=0.1). Complications occurred in 6 patients after PCNL (12%) including colonic injury, fever and excessive leakage via nephrostomy site after removal of PCN tube. Colonic injury in a single case was the single major complication occurred after PCNL. Bleeding after PCNL was mild in our study and was managed conservatively without need for blood transfusion, embolisation or conversion to open surgery. Two cases required URS after ESWL for management of ureteric stones obstructing the treated kidney. We concluded that ESWL should be the first line of treatment of lower calyceal stones up to 2.5 cm length. This is due to high effectiveness (90% success rate), non invasive nature, minimal anesthetic requirements and high level of patient and physician acceptance. PCNL, although more effective than ESWL (96% success rate) is more invasive more technically demanding, needs anaesthesia and carries a higher risk of complications. We recommend PCNL for LPS in patients with narrow LISA (narrower than 52mm2) and in patients with large calyceal volume (more than 3.5 cm3) and in obese patients (with BMI more than 29) as an initial therapy. PCNL should be used as salvage therapy after failure of ESWL.