Minimally invasive method selection in upper urinary tractstones

Urinary system stone disease represents an important area of urology in terms of its lifetime probability and consequences. The fact that our country is an endemic region in kidney stone disease offers physicians alternatives in treatment and approach. Extracorporeal shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) are frequently used minimally invasive treatment modalities. In our study, we aimed to distinguish this two methods which have the same degree of recommendation in the treatment algorithm, however the priority of success on a patient basis has not been determined until today the one with higher success according to the data of the patient. In this study a total of 324 adult patients were included, 167 of whom were applied SWL and 157 who were applied RIRS between 01.09.2017 and 01.04.2022 at the first stage. Demographic data of the patients and noncontrast computed tomography (CT) measurements of the stones were retrospectively analyzed. Post-procedure radiological images were evaluated and recorded in terms of residual fragment. 10 different parameters were analyzed. At the second stage, between 01.04.2021 and 15.04.2022 a total of 40 adult patients, 20 of whom were treated with SWL and 20 with RIRS, included and predictivity was evaluated. In the first stage, we analyzed the pre-procedural data of 324 patients and calculated formulas that predicted the success of SWL and RIRS. In the second stage, 20 patients who were predicted to have higher SWL success as a result of the formulas; formula predicted the result with 90% accuracy, with 83.3% sensitivity and 92.8% specificity. In 20 patients who were predicted to have higher RIRS success, the sensitivity of the formula was 100%, the specificity was 20%, and it predicted the result with 80% accuracy. At the present time, small and medium-sized stones of the upper urinary tract can be considered as the gray zone in the choice of treatment method. The formulas we calculated for both methods predicted the treatment outcome with high accuracy. We think that this will facilitate the choice of treatment in cases where minimally invasive methods are equally recommended. Keywords: Kidney stones, shock wave lithotripsy, retrograde intrarenal surgery