NEW ORLEANS, LA USA (UroToday.com) - Dr. Michael Lipkin debated the management of 2 cm intrarenal stone with his mentor, Dr. Glenn Preminger at the ROCK Society session. Before their presentations, over 75% of the audients (urologists) chose PNL as the preferred management. After the presentations, 55% chose retrograde intrarenal surgery (RIRS) as the preferred management, suggesting that Dr. Lipkin made a strong point against Dr. Preminger. Of note, the EAU guidelines do not support RIRS for intrarenal stones > 2cm.
In his presentation, Dr. Lipkin demonstrated that despite stone-free rates and the need for a secondary procedure is less with PNL, the complication rate, hospital stay, and cost are less for RIRS. Serious complications can occur with PNL including injury to surrounding organs or aggressive bleeding. RIRS is usually done as an outpatient procedure in the U.S. Clearly the cost of RIRS is less than PNL. The costs of PNL and RIRS were determined at $19 845 and $6 675, respectively according to a study that looked at Medicare rates.
Dr. Preminger recommended PNL, as in the contemporary tubeless stentless PNL; the patient can go home the next day without a ureteric internal stent that can lead to stent-related symptoms or pain. Both urologic experts from Duke University demonstrated the efficacy and safety of endourological management of 2 cm intrarenal stones. The debate still continues much like many other debates in urology and stone management. Moreover, it seems that SWL is not a recommended option anymore; at least in high-volume centers in the U.S. Dr. Preminger presented his opinion about how SWL should really be retired in an earlier crossfire at AUA 2015.
Presented by Michael Lipkin and Glenn Preminger at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Duke University Medical Center, Durham, NC USA