Treatment of Lower Pole Renal Stones. Extracorporeal Shockwave Lithotripsy Versus Intrarenal and Percutaneous Surgery

espanolIntroduccion: la litotricia extracorporea por ondas de choque (LEOC) es el tratamiento usado en el 80-90% de los casos de litiasis renal. Las tecnicas endourologicas como la cirugia intrarrenal retrograda (CIR), la nefrolitotomia percutanea (NLP) y sus miniaturizaciones (miniperc) estan ganando importancia gracias a su alta eficacia. Cuando se trata del caliz inferior la litotricia extracorporea es la que presenta peores resultados, pero es dificil determinar las indicaciones para tratar con una tecnica concreta. El objetivo de esta revision es determinar la eficacia y seguridad de estas tecnicas en el manejo de la litiasis renal en caliz inferior. Material y metodos: revision de 12 estudios que evaluan resultados de una, dos o las tres tecnicas en terminos de eficacia, tiempo de intervencion, estancia hospitalaria, complicaciones, maniobras auxiliares y re-tratamiento. Resultados: la LEOC presenta peores resultados cuando el calculo es de mediano tamano, menor tiempo de intervencion y estancia, mas complicaciones y altas tasas de re-tratamiento. La eficacia de la CIR y la NLP no se ve tan afectada por el tamano de la litiasis, presentando buenos resultados y menores tasas de litiasis residuales, pero mayor tiempo de intervencion y de estancia hospitalaria. Conclusiones: la litotricia extracorporea presenta resultados inferiores, pero bastante aceptables considerando su baja invasividad y corta estancia hospitalaria, caracteristicas que la hacen preferible en pacientes seleccionados. Las tecnicas endourologicas demuestran una gran eficacia a expensas de ser mas invasivas y costosas, aunque a veces sean preferibles para evitar la necesidad de re-tratamiento. EnglishIntroduction: extracorporeal shockwave lithotripsy (SWL) is used in the 80-90% of the cases of renal lithiasis. Endourological techniques such as retrograde intrarenal surgery (RIRS) or percutaneous nephrolithotomy (PCNL) and its miniaturizations (miniperc) are gaining importance because they are highly effective treatments. Regarding the treatment of the nephrolithiasis of the lower pole, the extracorporeal lithotripsy presents worse results, but it still difficult to set up the indications to treat with a certain technique. The purpose of this review is to stablish the effectivity and safety profile of these techniques in the management of the lower renal pole lithiasis. Materials and Methods: we conducted a review of 12 studies that evaluate results of one, two or three of the techniques in terms of effectivity, operative time, hospital stay, complications, auxiliary procedures and re-treatment. Results: SWL presents lower stone-free rates when the lithiasis is medium or big sized, shorter operative time and hospital stay, more complications and high rates of re-treatment. The effectivity of RIRS and PCNL does not change a lot with larger lithiasis, presenting good results and lower residual lithiasis rates. The longer operative time was performed with RIRS and the longer hospital stay with PCNL. The complications rate varies, being more important with PCNL. Re-treatment rates are low with RIRS and PCNL. Conclusions: these three techniques show good results in the management of lower pole lithiasis, although SWL presents worse results in comparison, but considering its reduced invasiveness and short hospital stay, it is the chosen technique for many patients. Endourological techniques show better results at expense of their invasiveness and higher cost, although sometimes they are preferable in order to prevent re-treatment.