UroToday - In this very important and unique study, the authors note that at 19.2 years average follow-up after percutaneous stone removal (PCNL), the incidence of hypertension (34.1%) is no different than after shock wave lithotripsy (SWL) (36.4%).

Of note, the incidence of diabetes (23.5%) at first appeared to be higher than after SWL (16.8%) but in a multivariate analysis taking into account BMI and stone size, the difference did not hold up.

Interestingly, renal insufficiency developed in 10.6% while ureteropelvic junction obstruction was noted in 3.5%. Stone recurrence was directly related to failure to achieve a stone free state; the overall stone recurrence rate was 37%. This recurrence rate was less than after SWL (53.5%).

The bottom line: if you need to treat a stone patient, PCNL and SWL are equivalent with respect to long term adverse medical outcomes; however, according to the same authors, neither PCNL nor SWL provide as sanguine an outcome as the stone patient who requires no operation - based on the control population from their earlier study. 1

What is now needed, is a similar 19 year follow-up study of the long-term impact of ureteroscopy for stones and a similar multivariate analysis based on stone size and BMI.

1 Krambeck, A., E., Gettman, M. T., Rohlinger, A. L., Lohse, C. M., et al.: Diabetes Mellitus and Hypertension Associated with Shock Wave Lithotripsy of Renal and Proximal Ureteral Stones at 19 Years of Follow-up. J. Urol. 175: 1742, 2006.

Krambeck AE, Leroy AJ, Patterson DE, Gettman MT

J Urol. 2008 Jun;179(6):2233-7
doi:10.1016/j.juro.2008.01.115

Reported by UroToday Medical Editor Ralph V. Clayman, MD

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