Cubuk Alkan, Özkaptan Orkunt, Sahan Ahmet
Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey.
Urol J. 2021 Jan 26;18(3):351-352. doi: 10.22037/uj.v16i7.6590.
We read the article entitled ''Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm: A Meta-analysis and Systematic Review'' published in Urology Journal (1). The topic is still hot in urology regarding lower pole kidney stones in 10-20 mm diameters. Although extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the available options for the patients with lower pole renal stones 10-20 mm diameter, the decision making among the methods is still controversy. This manuscript is valuable in this regard. At the present manuscript, the authors prepared a very comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. They emphasized the longer operative time of PCNL and RIRS compared to ESWL. They also reported a higher stone-free rate, the lower retreatment rate and auxiliary procedure following PCNL with the longest hospital stay for PCNL. When it comes to ESWL, the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay was reported. The authors indicated stone to skin distance (SSD) as an unfavourable factor for ESWL. This issue is also reported in current literature. SSD was calculated by measuring the distance from the stone to the skin in three angles (0°, 45° and 90°) and the cut-off value for SWL failure was reported in a wide-scale from 100 mm to 119 mm(2,3). At the present study, the authors presented 10 mm as a predictive value for the criteria of SWL failure. This statement seems to be not correct totally also 10 mm is an impossible value for SSD. In our opinion, it was caused by a misspelling, and a correction may be informative for the readers.
我们阅读了发表于《泌尿学杂志》（1）的题为《逆行性肾内手术与经皮肾镜取石术及体外冲击波碎石术治疗直径10 - 20mm下极肾结石的Meta分析与系统评价》的文章。在泌尿外科领域，直径10 - 20mm的下极肾结石这一话题仍然热门。虽然体外冲击波碎石术（ESWL）、逆行性肾内手术（RIRS）和经皮肾镜取石术（PCNL）是直径10 - 20mm下极肾结石患者可选择的治疗方法，但在这些方法之间进行决策仍存在争议。在这方面，该手稿很有价值。在当前这份手稿中，作者对现有证据进行了非常全面的Meta分析，以量化和比较PCNL、RIRS和ESWL治疗直径10 - 20mm下极肾结石的安全性和有效性。他们强调与ESWL相比，PCNL和RIRS的手术时间更长。他们还报告了PCNL的无石率更高、再次治疗率和辅助手术率更低，但住院时间最长。说到ESWL，报告的无石率最低、再次治疗率和辅助手术率更高，但手术时间短且住院时间最短。作者指出结石与皮肤距离（SSD）是ESWL的一个不利因素。当前文献中也报道了这个问题。通过在三个角度（0°、45°和90°）测量结石到皮肤的距离来计算SSD，SWL失败的临界值在100mm至119mm范围内有广泛报道（2,3）。在本研究中，作者提出10mm作为SWL失败标准的预测值。这种说法似乎也不完全正确，而且10mm对于SSD来说是一个不可能的值。我们认为，这是由拼写错误导致的，进行修正可能会对读者有帮助。
