Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery (ENDOUROLOGY AND STONE DISEASES)

INTRODUCTION With the advancements in endourologic technology, in the last 30 years, renal stone treatment has dramatically changed, and minimally invasive treatments options, such as extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), mini-PCNL, retrograde intrarenal surgery (RIRS) or laparoscopy, have replaced open surgery. The primary aim of all of these procedures is to maximize the removal of stones with minimal morbidity. Although, minimally invasive treatment modalities have an excellent stone fragmentation rate, the clearance of stone fragments may not be immediate and can occur for any time after the intervention. Additionally, clearance of stone fragments may not have an immediate clinical concern but are likely to affect the patient’s well-being in the long term. If the spontaneous passage of the stone fragments is prolonged, additional procedures, labor loss and hospital admittance due to renal colic episodes, increase. Thus, the total cost caused by the condition and treatment increases and treatment compliance dramatically decreases. The European Association of Urology (EAU) guidelines, recommends PCNL for renal pelvic stones greater than 2 cm, and SWL is suggested primarily for stones less than 1 cm in size. Although SWL, RIRS and PCNL are all presented as treatment options for stones between 1 and 2 cm in size, which application is a matter of preference. The choice of treatment decision usually depends on many factors, such as patient/ doctor preference, success rate, patient’s comorbidities, complications of the treatment, treatment costs, existing surgical equipment, stone clearance time, and patient’s compliance. In the decision-making process, patients are informed about each procedure’s success rates, possible complications, invasiveness, the need for anesthetics, and hospital stay. However, there is no clear information for the patient regarding the amount of time taken to clear the stones from the urinary system after treatment. Although stone clearance times for ureteral stones are widely studied, few reports have studied the elimination of renal stones after SWL,