Treatment options for active removal of renal stones

Abstract

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from the PubMed database and the European Association of Urology (EAU) guidelines. ESWL remains the option of choice for stones with diameter ≤ 20 mm due to its low invasive character, whereas PCNL is the standard for stones with diameter > 20 mm because of its high stone-free rates. Although ESWL treatment has become more patient friendly, its efficacy has not improved. On the other hand, URS has gained renewed interest due to new technological developments and improved treatment methods.

Comparison of standard-percutaneous nephrolithotomy combined ultrasonic lithotripsy system and mini-percutaneous nephrolithotomy combined high-power holmium laser for staghorn calculus: A retrospective comparative study

“…Repeated infection causes the stone increasing. The stone enlargement and hydronephrosis easily lead to infection, a vicious cycle, and aggravate renal function damage, If the treatment is not timely, it is likely to cause the loss of renal function of patients in serious cases [21]. Therefore, active treatment of staghorn calculus is of key signi cance to ensure the health of patients.…”

Percutaneous nephrolithotomy: Three-needle technique on two planes. Cury’s technique

“…Percutaneous nephrolithotomy replaced open surgery for the treatment of these calculi, as the reduction in morbidity and improvement in the experience of surgeons led to the increased indication for this procedure (5,6). According to the guidelines of the European Association of Urology and American Urological Association, the percutaneous approach is indicated for renal calculi larger than 2 cm in diameter or calculi located in the inferior pole larger than 1.0 cm in diameter (2,3).…”

Does Stone Entrapment With "Uro-Net" Improve Ho:YAG Laser Lithotripsy Efficiency in Percutaneous Nephrolithotomy and Cystolithopaxy?: an In Vitro Study

“…The ability to fragment any stone composition allied to a secure profile for the urinary tract and development of small fibers suitable for flexible endoscopy led the Holmium:Yttrium--Aluminum-Garnet Laser (Ho:YAG) to become the preferred energy source for stone breakdown during ureteroscopy (URS) (2)(3)(4)(5). In contrast, intracorporeal lithotripsy during percutaneous nephrolithotomy (PCNL) and cystolithopaxy (CYS) is usually performed by ultrasonic or pneumatic devices as fragmentation and extraction can be performed with greater efficiency (6)(7)(8). Percutaneous applications of laser lithotripsy are usually reserved to treat branched or difficult to access stones with the flexible nephroscope.…”