Comparison of Stone Clearance in Extracorporeal Shock Wave Lithotripsy versus Micro-Percutaneous Nephrolithotomy in Patients with Small Renal Calculi

Stone Clearance in ESWL vs. Micro-PCNL for Small Renal Calculi

Abstract

Background: Renal calculi are a common urological problem, and the choice between minimally invasive options depends mainly on stone size and location. Extracorporeal shock wave lithotripsy (ESWL) and micro-percutaneous nephrolithotomy (Micro-PCNL) are standard treatments for small renal stones, but their comparative efficacy remains uncertain. Objective: To compare stone clearance outcomes of ESWL and Micro-PCNL in patients with small renal calculi. Study Design: Quasi-experimental study. Settings: Department of Urology, Sir Ganga Ram Hospital, in collaboration with Jinnah Hospital, Lahore, Pakistan. Duration: 16th July 2021 to 15th August 2022. Methods: Following ethical approval, 92 patients aged 18–65 years with renal stones <1.5 cm and normal renal anatomy were enrolled through non-probability consecutive sampling and divided equally into ESWL and Micro-PCNL groups (n = 46 each). Stone-free status was assessed by X-ray KUB. Data were analyzed using the Chi-square test, with p < 0.05 considered significant. Results: Mean stone size was 14.5 ± 0.50 mm in the Micro-PCNL group and 11.8 ± 2.64 mm in the ESWL group. Stone-free rates were 63% and 65.2%, respectively (p = 0.82). However, for stones >13 mm, Micro-PCNL achieved significantly higher clearance (63%) compared to ESWL (29.4%) (p = 0.018). Conclusion: Both ESWL and Micro-PCNL are effective for small renal stones, with no significant difference in overall clearance rates. Micro-PCNL, however, provides better outcomes for stones larger than 13 mm, making it a more suitable choice for slightly larger calculi within the small-stone category.