Comparison of outcomes of extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery in the management of renal calculi measuring one to two centimeters.

OBJECTIVES

To compare outcomes of extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) for renal stones measuring 1-2 cm, including stone clearance, hospital stay, hematuria, sepsis, postoperative pain, and retreatment.

METHODOLOGY: Six months, single-center, open-label, parallel-group randomized controlled trial was conducted at the Department of Urology, Dr. Ziauddin Hospital, North Nazimabad, Karachi, from September 5, 2025 to March 4, 2026. Ninety-eight eligible adults were enrolled consecutively and randomized 1:1 to ESWL or RIRS by lottery method using concealed identical allocation slips. Non-contrast CT-KUB was performed at baseline and at 28 days. Pain was assessed by VAS at 24 hours. Data were analyzed using SPSS version 26, with p<0.05 considered significant.

RESULTS

Baseline characteristics were comparable between the treatment groups. Stone-free status after one session was 53.1% with ESWL and 85.7% with RIRS (RR 1.62, 95% CI 1.21 to 2.15; p<0.001), while 28-day stone clearance was 67.3% and 85.7%, respectively (RR 1.27, 95% CI 1.02 to 1.60; p=0.032). ESWL was associated with shorter hospital stay (p<0.001). Median VAS pain score at 24 hours was higher after ESWL [4 (IQR 3-4)] than RIRS [3 (IQR 2-4); p<0.001]. Retreatment was more frequent after ESWL (30.6% vs 10.2%; RR for RIRS vs ESWL 0.33, 95% CI 0.13 to 0.85; p=0.012), while gross hematuria and postoperative sepsis were comparable.

CONCLUSION

RIRS provided higher clearance and lower retreatment and pain scores than ESWL, while ESWL was associated with shorter hospital stay. Registration Number: www. clinicaltrials.gov (NCT07261995).