Results of minimally invasive procedures for ESWL refractory renal stones smaller than 2 cm: A single center experience.

OBJECTIVES: To evaluate the efficacy and reliability of endourological procedures in patients with renal stones up to 2 cm that were found to be resistant to extracorporeal shock wave lithotripsy (ESWL). METHODS: 611 patients who had undergone ESWL due to renal stones up to 2 cm at the ESWL unit of our clinic, were retrospectively evaluated. Standard percutaneous nephrolithotomy (PNL), micro-PNL, retrograde intrarenal surgery (RIRS) was performed on the patients who had stones resistant to ESWL. Demographic data, stone free rate, duration of hospital stay, duration of operation, the duration of scopy, the rates of transfusion and the complications were recorded. RESULTS: The mean age of 611 patients included to the current study was 40.76 +/- 15.45 years, the mean size of stones was calculated as 205.47 +/- 90.5 mm(2). While the renal stones were removed in 468 patients (76.59%) after ESWL, endourological procedures were performed in 142 patients (23.24%) who had ESWL resistant stones. Standard PNL was performed in 73 patients (51.4%), RIRS was performed in 51 patients (35.91%), micro-PNL was performed in 18 patients (12.68%). The success rates after the surgical procedures were 93.15%, 90.16% and 88.88%, respectively. No major complication was observed in patient groups who had undergone RIRS and microPNL. CONCLUSION: The surgical approaches, which are selected according to the size and localization of stones, could provide a success rate of 98.03% in ESWL resistant stones and these procedures could be reliably performed with considerably lower complication rates.