Residual Stone Fragment after Percutaneous Nephrolithotomy; Shockwave Lithotripsy Vs Retrograde Intrarenal Surgery

Background and objectives: The integration of technology into percutaneous nephrolithotomy procedures has yet to eliminate the issue of residual stone fragments, which cause recurrence or blockage of ureters. The aim of the study is to evaluate and contrast effectiveness of extracorporeal-shockwave-lithotripsy with retrograde-intrarenal-surgery in residual stone fragments therapy following an initial standard percutaneous nephrolithotomy procedure. Methods: The analysis was retrospectively conducted on adult patients with residual stone fragments after doing percutaneous nephrolithotomy. These patients had either extracorporeal-shockwave-lithotripsy or retrograde-intrarenal-surgery at Sulaymaniyah Teaching Hospital and Harem hospital from January 2020 to January 2024. We assessed the stone free rate up to 90 days after the reintervention using ultrasonography, kidney, ureter and bladder radiography for the kidneys, Problems occurring at a 90-day were documented using the Clavien-Dindo system classification. Results: The examination comprised forty-six patients, with a mean age of 44.78 ± 12.38 years. Twenty-six patients were in retrograde-intrarenal-surgery group, while twenty were in extracorporeal-shockwave-lithotripsy group. The stone size in retrograde-intrarenal-surgery group mean was 9.50 ± 2.12 mm, compared to 9.55 ± 2.01 mm in extracorporeal-shockwave-lithotripsy group. The immediate stone-free rate was 84.6% in retrograde-intrarenal-surgery group and 30% in the extracorporeal-shockwave-lithotripsy group, while the final stone free rate after 3 months of follow-up was 97% for retrograde-intrarenal-surgery and 95% for extracorporeal-shockwave- lithotripsy group, while the final stone free rate after 3 months of follow-up was 97% for retrograde-intrarenal-surgery and 95% for extracorporeal-shockwave-lithotripsy. Conclusion: Following percutaneous nephrolithotomy, leftover stones are more effectively treated with retrograde-intrarenal-surgery than extracorporeal-shockwave-lithotripsy. Patients who underwent retrograde intrarenal surgery had greater rates of achieving stone-free status than those with extracorporeal-shockwave-lithotripsy treatment.