Objectives: The objective is to compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and
ultrasound‑guided (US‑guided) shock wave lithotripsy (SWL) for the treatment of radiolucent lower pole
calculi of 1–2 cm.
Materials and Methods: This prospective randomized study was performed at our tertiary care urology
institute of Benha University Hospitals; cases were randomized either to undergo RIRS (Group A) or US‑guided
SWL with a triple focus system (Group B). The safety and effectiveness of both therapies were compared
using new criteria for stone‑free rate (SFR): Grade A (absolutely stone free), Grade B (≤2 mm fragments),
and Grade C (>2 mm up to 4 mm fragments), fluoroscopy time, operative time, auxiliary procedures,
retreatment, and complications.
Results: Out of 100 patients, 92 were eligible for this study. RIRS had a higher SFR of 88.9% compared to
SWL, 72.3% (P = 0.045). Furthermore, stone‑free classification significantly differed between the studied
groups (P < 0.001), with Grade A being significantly higher in Group A. Conversely, Grades B and C were
lower in Group A. On the other hand, operative and fluoroscopy times were significantly reduced with
SWL (P = 0.004 and < 0.001, respectively). While complications did not significantly differ between the
two groups (P = 0.340), a significant distinction was observed in terms of the Clavien–Dindo classification.
Conclusions: RIRS is an effective and safe option for treating radiolucent lower calyceal stones of ≤2 cm,
with a greater SFR and lower need for auxiliary operations. However, Sono SWL is a cost‑effective alternative
that can achieve a comparable success rate after retreatment sessions.
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