Multimodality approach to renal and ureteric calculi

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Minimally invasive treatments for renal and ureteric calculi have largely replaced open surgery in Western countries.
• The adoption of these advanced techniques in India requires careful consideration of local socioeconomic factors and cost-effectiveness.
• Evaluating the suitability of various stone removal methods is crucial for patient care in diverse healthcare settings.

Purpose of the Study:

• To analyze the outcomes of different treatment modalities for renal and ureteric calculi in the Indian context.
• To compare the efficacy of extracorporeal shock wave lithotripsy, percutaneous litholapaxy, ureteroscopy, and open surgery.
• To provide evidence-based recommendations for stone management considering patient needs and economic factors in India.

Main Methods:

• A retrospective analysis of 596 renal units with renal and ureteric calculi treated over 16 months.
• Management strategies included extracorporeal shock wave lithotripsy, percutaneous litholapaxy, ureteroscopy, open surgery, and combination therapies.
• Data were collected to evaluate the success rates and suitability of each method based on stone characteristics and location.

Main Results:

• Out-patient lithotripsy showed good results for small stones in the renal pelvis, calyces, and non-impacted ureters.
• Percutaneous procedures were more effective than lithotripsy for large stones (>400 mm²), requiring fewer interventions.
• Open surgery was reserved for complex cases like large staghorn calculi or those associated with congenital anomalies, with a 6.4% overall application rate.

Conclusions:

• Extracorporeal shock wave lithotripsy in India should be reserved for cases where a rapid and successful outcome is anticipated.
• For larger or more complex calculi, minimally invasive techniques or surgical stone removal are often more appropriate.
• Treatment decisions must be individualized, balancing clinical effectiveness with the specific social, economic, and cost considerations relevant to patients in India.