Residual renal stone fragments remain a common clinical issue following percutaneous nephrolithotomy (PCNL), with reported incidence ranging from 10% to 30%. These fragments may act as a nidus for recurrent stone formation, infection, or obstruction, necessitating further intervention. Extracorporeal shock wave lithotripsy (ESWL) is widely used as a non-invasive treatment option for such residual stones; however, the optimal timing of ESWL after PCNL remains unclear.
Early application of ESWL may enhance stone clearance before fragment embedding or encrustation occurs, but it could be associated with increased risk of bleeding or infection due to incomplete renal healing. Conversely, delayed ESWL allows for better tissue recovery but may permit stone growth or persistence of symptoms.
This prospective randomized comparative study aims to evaluate the optimal timing of ESWL after PCNL in patients with residual renal stones ≤15 mm. Eligible patients will be randomized into two groups: early ESWL (within 7-14 days after PCNL) and delayed ESWL (after 3-4 weeks). The primary outcome is the stone-free rate at 3 months, while secondary outcomes include complication rates, pain scores, renal function changes, and the need for additional interventions.
The results of this study are expected to provide evidence-based guidance on the ideal timing of ESWL following PCNL to maximize efficacy and minimize complications.
Age 18-70 years.
Single or multiple residual renal stones ≤15 mm after PCNL.
Normal renal function (serum creatinine <1.5 mg/dL).
No active UTI.
Bleeding disorders or anticoagulant therapy.
Obstructed drainage or active sepsis.
Stones >15 mm or requiring secondary PCNL.
Parallel
Extracorporeal shock wave lithotripsy (ESWL)
Procedure/SurgeryExtracorporeal shock wave lithotripsy (ESWL) is performed using a standardized protocol for treatment of residual renal stones ≤15 mm after percutaneous nephrolithotomy (PCNL). All patients are treated using the same lithotripter model with standardized energy settings and shock frequency according to EAU guidelines. Sedation is administered as needed. A maximum of three ESWL sessions is allowed. Follow-up imaging is performed to assess stone clearance.
Stone-Free Rate at 3 Months
The proportion of patients who are stone-free, defined as no residual fragments greater than 2 mm on imaging (ultrasound or CT scan) at 3 months after ESWL treatment.
Complication Rate
The incidence of postoperative complications including hematuria, fever, and urinary tract infection following ESWL treatment.
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