Interventional stress in renal stone treatment

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Renal stone treatment involves various minimally invasive techniques.
• Assessing interventional stress is crucial for comparing treatment efficacy and patient outcomes.
• Interleukin-6 (IL-6) and C-reactive protein (CRP) are key biomarkers of systemic inflammatory response.

Purpose of the Study:

• To compare the interventional stress of shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and minimally invasive percutaneous nephrolitholapaxy (MIP).
• To evaluate stress by measuring changes in serum IL-6 and CRP levels during renal stone treatment.

Main Methods:

• A prospective study involving 143 patients with renal pelvic stones.
• Patients were treated with SWL (n=40), RIRS (n=74), or MIP (n=29).
• Serum IL-6 and CRP levels were measured 24 hours before and after the procedure to assess interventional stress.

Main Results:

• No significant differences in mean IL-6 or CRP level changes were observed between SWL, RIRS, and MIP groups (P=0.20 for IL-6, P=0.79 for CRP).
• Mean stone sizes significantly differed across the groups, with MIP treating substantially larger stones (P<0.0005).
• Despite larger stone burdens in the MIP group, inflammatory markers did not show increased stress compared to SWL and RIRS.

Conclusions:

• Contrary to the common perception of SWL as the least invasive, this study found no significant differences in measured stress markers between SWL, RIRS, and MIP.
• The inflammatory response, as indicated by IL-6 and CRP, appears comparable across these minimally invasive renal stone therapies.
• These findings suggest that the choice of minimally invasive renal stone treatment may not be dictated by differences in acute interventional stress as measured by these biomarkers.