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Urology. 2015 Jan;85(1):33-7. doi: 10.1016/j.urology.2014.08.023. Epub 2014 Oct 18      5/28/2016

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Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial.
Sener NC1, Bas O2, Sener E3, Zengin K4, Ozturk U5, Altunkol A6, Evliyaoglu Y6.
Author information
1Department of Urology, Numune Teaching and Research Hospital, Yuregir, Adana, Turkey. Electronic address: cansener14@gmail.com.
2Department of Urology, Onkoloji Education and Research Hospital, Ministry of Health, Ankara, Turkey.
3Department of Radiology, Ceyhan State Hospital, Ceyhan, Adana, Turkey.
4Department of Urology, Bozok University, Yozgat, Turkey.
5Department of Urology, Diskapi Yildirim Beyazid Education and Research Hospital, Ministry of Health, Ankara, Turkey.
6Department of Urology, Numune Teaching and Research Hospital, Yuregir, Adana, Turkey.
Abstract
OBJECTIVE:
To present the outcomes of flexible ureteroscopy (F-URS), shock wave lithotripsy (SWL), and observation in the management of asymptomatic lower calyceal stones.
METHODS:
A total of 150 patients with asymptomatic lower calyceal stones were randomized into F-URS (group 1), SWL (group 2), and observation (group 3) groups. The main criteria for patient enrollment were having asymptomatic single lower pole stones <1 cm.
RESULTS:
In F-URS, the mean stone-free rate was 92% (46 of 50). The mean number of sessions for the SWL group was 1.48 ± 0.65. Stone-free rate was 90% (45 of 50). In the observation group, patients were followed up for a mean of 21.02 ± 3.65 months. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during follow-up, and 2 of them passed a stone and responded to analgesics without further treatment. Complication rates for groups 1 and 2 were similar, but group 2 had higher Clavien grades.
CONCLUSION:
For asymptomatic small-sized lower calyceal stones, SWL and F-URS are established treatment modalities. However, with low auxiliary treatment rates, observation may be an option for the management of nonsymptomatic small-sized lower pole kidney stones

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