Efficacy and Safety of Percutaneous Nephrolithotomy in Treating Lower Calyceal Renal Stone of 1-2 centimeter in Favorable Lower Pole Calyceal Anatomy: Comparison with Extracorporeal Shock Wave Lithotripsy

Background: Renal stones commonly occur in the lower pole calyx, making treatment challenging due to anatomical factors. The main treatment options for lower calyceal stones are extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). ESWL is preferred for stone <1cm, while PCNL is preferred for stone >2cm. However, for 1-2 cm stone with favorable lower pole calyceal anatomy, both treatments are practiced. ESWL is non-invasive with fewer complications but has lower stone clearance requiring multiple sessions. Objective: To evaluate efficacy and safety of PCNL compared to ESWL in treating lower calyceal renal stone of 1-2 cm in favorable lower pole calyceal anatomy. Methods: This was a single center quasi-experimental study on 44 patients, divided into two groups: group A (experimental group) and group B (control group), from January 2023 to August 2024 in the Department of Urology, Bangladesh Medical University (BMU), Shahbag, Dhaka. The unilateral, single, radiopaque, 1-2 cm sized lower calyceal renal stone in favorable lower pole calyx anatomy was included in the study. The computed tomography urogram (CTU) was carried out to assess the favorable infundibular characteristics, stone size, Hounsfield unit and skin to stone distance. Experimental group underwent PCNL and control group, ESWL. Operation duration, post operative complications determined by modified Clavien Dindo, duration of hospital stay and stone clearance were evaluated between the groups. Continuous variables were analyzed by t-test and categorical variables by chi-square test and fisher’s exact test. P-value <0.05 was considered statistically significant. Results: Experimental group (65±13.54 minutes) had shorter operation time compared to control group (70.23±23.73 minutes); but the difference was not statistically significant (p=0.374). Grade-1 complication was more in control group than experimental group. While grade-2 complication was more in experimental group than control group but overall complication rate was identical (p=0.763) between two groups. Duration of hospital stay was significantly shorter (p<0.01) in control group (11.09±3.89 hours) than experimental group (77.45±22.13 hours). Stone clearance was significantly (p=0.012) higher in experimental group (81.1%) than control group (45%). Conclusion: PCNL offers better stone clearance but require longer hospital stay than ESWL with identical operation time and complication rates between them. Bangladesh Medical Res Counc Bull 2025;51(1):18-24