Abstract:

Objective: In this study, we compared the effects of extracorporeal shock wave lithotripsy SWL and percutaneous nephrolithotomy PNL on local and global renal functions by single photon emission computed tomography SPECT . Materials and Methods: Patients with renal pelvis stones sized between 1.5 and 2.5 cm were prospectively randomised into SWL n22 and PNL n:20 groups between February 2006-December 2011. An electrohydraulic generator was used for SWL. A single posterior lower caliceal access was used for PNL. Technetium99m-dimercaptosuccinic acid Tc99m-DMSA was used for SPECT scans. SPECT scans, obtained one week before and 6 months after treatment, were compared for local and global renal functions. Results: 15 68% cases of SWL group mean stone size:19,3±3mm were stonefree after treatment average shock number: 5458±1251 . There were residual fragments in the lower calyx in 5 cases. Ureterorenoscopic pneumatic lithotripsy was performed in another 2 cases due to nonpassing ureteral fragments. Stones of the patients in PNL group mean stone size:20,1±2,4mm were removed completely. When pretreatment and posttreatment SPECT scans were compared, loss in local and global uptakes of the treated kidneys were 2,64±0,83% and 3,36±0,78% in SWL group and 1,56±0,62% and 2,68±1,1% in PNL group, respectively. There was no significant difference between groups. Conclusion: Although SWL seems a less traumatic method in treatment of renal calculi, several repeat sessions are required for large calculi. So, the consequent parenchymal injury is more after SWL. When a decision is to be made between SWL and PNL for treatment of renal calculi, this situation should be considered

Keywords: