Retrograde Intrarenal Surgery or Shock Wave Lithotripsy?: Comparison of the Effects on Renal Functions by Glomerular Filtration Rate
Journal of Urological Surgery
Objective: In this study, we aimed to evaluate and compare the effects of retrograde intrarenal surgery (RIRS) and schok wave lithoripsy (SWL) interventions on renal functions by analyzing glomerular filtration rate (GFR) values. Materials and Methods: A total of 95 patients, who underwent RIRS or SWL in 2017 at Gülhane Training and Research Hospital, were included in this retrospective study. Forty-six of these patients (48.4%) were in RIRS group and 49 (51.6%) were in SWL group. Preoperative,
... roup. Preoperative, early-postoperative (on the first postoperative day) and late-postoperative (on the first postoperative month) GFR values were calculated using the "abbreviated Modification of Diet in Renal Disease" Method. Changes in GFR values after RIRS and SWL treatments were compared statistically. Results: When the early postoperative and late postoperative GFR levels were compared, a statistically significant difference was observed between the groups (p=0.04 and p<0.001, respectively). For RIRS group, there was a 0.37±13.5 mL/min/1.73 m² increase and for SWL group, there was 5.65±12.5 mL/min/1.73 m² increase in GFR values in the early postoperative period. There was a 2.40±14.1 mL/min/1.73 m² decrease in RIRS group and 7.75±11.8 mL/min/1.73 m² increase in SWL group in GFR values in the late postoperative period. In general linear model, there was a statistically significant difference in changes in GFR over time between RIRS and SWL groups (p=0.002). There was also a statistically significant difference when the changes in GFR over time were compared according to stone locations (p=0.02). Conclusion: RIRS is associated with less improved GFR in comparison with SWL. SWL should be considered as first line treatment for kidney and ureteral stones when considering the changes in GFR values comparing to RIRS especially for stones smaller than 20 mm. Keywords: Glomerular filtration rate (GFR), Modification of Diet in Renal Disease (MDRD), Renal function, Retrograde intrarenal surgery (RIRS), Shock wave lithotripsy (SWL), Urolithiasis Amaç: Bu çalışmada, retrograd intrarenal cerrahi (RIRS) ve şok dalgası litotripsi (SWL) işlemlerinin renal fonksiyonlar üzerindeki etkisini glomerüler filtrasyon hızı ölçümü (GFR) ile değerlendirmeyi ve karşılaştırmayı amaçladık. Gereç ve Yöntem: 2017 yılında Gülhane Eğitim ve Araştırma Hastanesi'nde RIRS veya SWL işlemi uygulanan toplamda 95 hasta bu retrospektif çalışmaya dahil edildi. Hastaların 46'sı (%48,4) RIRS, 49'u ise (%51,6) SWL grubundaydı. Operasyon öncesi, operasyon sonrası erken dönem (post-op Abstract Öz In this paper, we showed that there is a significant glomerular filtration rate decrease after retrograde intrarenal surgery when compared with schok wave lithoripsy (SWL) especially the stones with a diameter of less than 20 mm in both of early and late post-operative period. This is significant because we believe that our study will have an important place in the literature because best of our knowledge this is the first research in the literature which one compares the renal functional outcomes after RIRS and SWL.