Comparative Outcomes of Endourological Procedures in Urolithiasis: A Narrative Literature Review of PCNL, URS, and ESWL
DOI:
https://doi.org/10.46880/jkm.v18i2.5817Kata Kunci:
urolithiasis, PCNL, ureteroscopy, retrograde intrarenal surgeryAbstrak
Urolithiasis remains a recurrent and resource-intensive condition, where endourological interventions are selected based on stone burden, location, anatomy, patient preference, stone-free rate, safety, retreatment, recovery, and cost. This narrative review assesses percutaneous nephrolithotomy (PCNL), ureteroscopy or retrograde intrarenal surgery (URS/RIRS), and extracorporeal shock wave lithotripsy (ESWL/SWL). PCNL consistently has the best chance of getting rid of stones, especially for bigger stones, stones in the lower pole, or complicated kidney stone burdens. However, these benefits come with more invasive procedures, longer hospital stays, and more bleeding-related illnesses. ESWL is still the least invasive and often the least expensive option, but the results depend more on the size, density, position, and the gap between the stone and the skin, as well as the need for repeat sessions. Recent evidence suggests that treatment selection should not be limited to a single efficacy hierarchy: PCNL, URS, and ESWL each serve distinct therapeutic functions, and optimal decision-making requires the alignment of procedural benefits with stone- and patient-specific priorities.
Keywords: urolithiasis, PCNL, ureteroscopy, retrograde intrarenal surgery, ESWL
Referensi
Akram, M., Jahrreiss, V., Skolarikos, A., Geraghty, R., Tzelves, L., Emilliani, E., Davis, N. F., & Somani, B. K. (2024). Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. Journal of Clinical Medicine, 13(4), 1114. https://doi.org/10.3390/jcm13041114
Assimos, D., Krambeck, A., Miller, N. L., Monga, M., Murad, M. H., Nelson, C. P., Pace, K. T., Pais, V. M., Pearle, M. S., Preminger, G. M., Razvi, H., Shah, O., & Matlaga, B. R. (2016). Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. Journal of Urology, 196(4), 1161–1169. https://doi.org/10.1016/j.juro.2016.05.091
Ates, T., Akdogan, N., Yılmaz, I. O., Arıkan, M. G., & Deger, M. (2025). Percutaneous nephrolithotomy versus retrograde intrarenal surgery on mid-sized lower calyx stones– a systematic review of last decade. BMC Urology, 25(1), 84.
https://doi.org/10.1186/s12894-025-01771-1
Bai, S., Zhan, Y., Pan, C., Liu, G., Li, J., & Shan, L. (2023). Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non–lower pole kidney stones under the COVID-19 pandemic. Urolithiasis, 51(1), 38. https://doi.org/10.1007/s00240-023-01412-y
Bowen, D. K., Song, L., Faerber, J., Kim, J., Scales, C. D., & Tasian, G. E. (2020). Re-Treatment after Ureteroscopy and Shock Wave Lithotripsy: A Population Based Comparative Effectiveness Study. Journal of Urology, 203(6). https://doi.org/10.1097/JU.0000000000000712
Chung, D. Y., Kang, D. H., Cho, K. S., Jeong, W. S., Jung, H. Do, Kwon, J. K., Lee, S. H., & Lee, J. Y. (2019). Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis. PLOS ONE, 14(2), e0211316. https://doi.org/10.1371/journal.pone.0211316
Croghan, S. M., Skolarikos, A., Jack, G. S., Manecksha, R. P., Walsh, M. T., O’Brien, F. J., & Davis, N. F. (2023). Upper urinary tract pressures in endourology: a systematic
review of range, variables and implications. In BJU International (Vol. 131, Number 3). https://doi.org/10.1111/bju.15764
Geraghty, R. M., Jones, P., Herrmann, T. R. W., Aboumarzouk, O., & Somani, B. K. (2018). Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis. World Journal of Urology, 36(11), 1783–1793. https://doi.org/10.1007/s00345-018-2320-9
Geraghty, R. M., Jones, P., & Somani, B. K. (2017). Worldwide Trends of Urinary Stone Disease Treatment over the Last Two Decades: A Systematic Review. In Journal of Endourology (Vol. 31, Number 6). https://doi.org/10.1089/end.2016.0895
Kallidonis, P., Ntasiotis, P., Somani, B., Adamou, C., Emiliani, E., Knoll, T., Skolarikos, A., & Tailly, T. (2020). Systematic Review and Meta-Analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones Less Than 2 cm in Maximum Diameter. In Journal of Urology (Vol. 204, Number 3). https://doi.org/10.1097/JU.0000000000001013
Kang, S. K., Cho, K. S., Kang, D. H., Jung, H. Do, Kwon, J. K., & Lee, J. Y. (2017). Systematic review and meta-analysis to compare success rates of retrograde
intrarenal surgery versus percutaneous nephrolithotomy for renal stones >2-cm: An update. In Medicine (United States) (Vol. 96, Number 49). https://doi.org/10.1097/MD.0000000000009119
Lee, S. M., Collin, N., Wiseman, H., & Philip, J. (2019). Optimisation of shock wave lithotripsy: A systematic review of technical aspects to improve outcomes. In Translational Andrology and Urology (Vol. 8). https://doi.org/10.21037/tau.2019.06.07
MacLennan, S., Wiseman, O., Smith, D., Starr, K., Aucott, L., Hernández, R., Manson, P., Thomas, R., Clark, C. T., MacLennan, G., McRae, D., Bell, V., Cotton, S., Gall, Z., Turney, B., & McClinton, S. (2025). Updated Systematic Review and Meta-analysis of Extracorporeal Shock Wave Lithotripsy, Flexible Ureterorenoscopy, and Percutaneous Nephrolithotomy for Lower Pole Renal Stones. European Urology, 88(3), 231–239. https://doi.org/10.1016/j.eururo.2025.01.020
Nedbal, C., Geraghty, R., Tramanzoli, P., Sessa, D., Gauhar, V., Galosi, A. B., Gregori, A., & Somani, B. K. (2025). Cost and Effectiveness of Flexible Ureteroscopy Versus Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-analysis by the European Association of Urology Endourology Section. In
European Urology Focus (Vol. 11, Number 6). https://doi.org/10.1016/j.euf.2025.06.004
Perri, D., Berti, L., Pacchetti, A., Morini, E., Maltagliati, M., Besana, U., Pastore, A. L., Romero-Otero, J., Saredi, G., Centrella, D., Sighinolfi, M. C., Rocco, B., Micali, S.,
Qin, P., Zhang, D., Huang, T., Fang, L., & Cheng, Y. (2022). Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis. International Braz j Urol, 48(4), 637–648. https://doi.org/10.1590/s1677-5538.ibju.2021.0347
Setthawong, V., Srisubat, A., Potisat, S., Lojanapiwat, B., & Pattanittum, P. (2023). Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database of Systematic Reviews, 2023(8). https://doi.org/10.1002/14651858.CD007044.pub4
Shabana, W., Oquendo, F., Hodhod, A., Ahmad, A., Alaref, A., Trigo, S., Hadi, R. A., Nour, H. H., Kotb, A., Shahrour, W., & Elmansy, H. (2021). Miniaturized Ambulatory Percutaneous Nephrolithotomy Versus Flexible Ureteroscopy in the Management of Lower Calyceal Renal Stones 10-20 mm: A Propensity Score Matching
Analysis. Urology, 156. https://doi.org/10.1016/j.urology.2021.05.041
Terro, K., Vanthoor, J., & Wiseman, O. (2026). Evaluation of outcomes in kidney stone management: stone-free rate vs. cost vs. quality of life: a systematic review from EAU endourology. World Journal of Urology, 44(1), 316. https://doi.org/10.1007/s00345-026-06385-2
Tran, K. B., Lang, J. J., Compton, K., Xu, R., Acheson, A. R., Henrikson, H. J., Kocarnik, J. M., Penberthy, L., Aali, A., Abbas, Q., Abbasi, B., Abbasi-Kangevari, M., Abbasi-Kangevari, Z., Abbastabar, H., Abdelmasseh, M., Abd-Elsalam, S., Abdelwahab, A. A., Abdoli, G., Abdulkadir, H. A., … Murray, C. J. L. (2022). The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 400(10352), 563–591.
Tzelves, L., Geraghty, R., Mourmouris, P., Chatzikrachtis, N., Karavitakis, M., Somani, B., & Skolarikos, A. (2022). Shockwave Lithotripsy Complications According to Modified Clavien-Dindo Grading System. A Systematic Review and Meta-regression Analysis in a Sample of 115 Randomized Controlled Trials. European Urology Focus, 8(5), 1452–
https://doi.org/10.1016/j.euf.2021.11.002
Wagenius, M., Oddason, K., Utter, M., Popiolek, M., Forsvall, A., Lundström, K. J., & Linder, A. (2022). Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scandinavian Journal of Urology, 56(3). https://doi.org/10.1080/21681805.2022.2055137
Wymer, K. M., Sharma, V., Juvet, T., Klett, D. E., Borah, B. J., Koo, K., Rivera, M., Agarwal, D., Humphreys, M. R., & Potretzke, A. M. (2021). Cost-effectiveness of Retrograde Intrarenal Surgery, Standard and Mini Percutaneous Nephrolithotomy, and Shock Wave Lithotripsy for the Management of 1-2cm Renal Stones. Urology, 156. https://doi.org/10.1016/j.urology.2021.06.030
Yang, Y. H., Wen, Y. C., Chen, K. C., & Chen, C. (2019). Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis. World Journal of Urology, 37(5). https://doi.org/10.1007/s00345-018-2443-z
Zeinelabden, K. M., Abdelhalim, E., Galal, M., Abdelbaky, T., & Nabeeh, H. (2024). Flexible ureteroscopy, extracorporeal shock wave lithotripsy and mini percutaneous nephrolithotomy for management of lower
pole renal hard stones ≤ 2 cm: a prospective randomized study. BMC Urology, 24(1). https://doi.org/10.1186/s12894-024-01644-z
INDEKS
