Managing a 2.2 cm Kidney Stone: SWL vs. PCNL Treatment Options

What is the recommended management for a 2.2 cm kidney stone?

Hello, doctor.
On March 5th of this year, a CT scan revealed a right kidney stone measuring approximately 2.2 cm (with the shorter side measuring about 1.9 cm).
A urologist in the southern part of Taiwan indicated that the stone is too large and should be treated with percutaneous nephrolithotomy (PCNL), as using shock wave lithotripsy (SWL) could likely cause complete obstruction of the urinary tract, and health insurance does not cover stones larger than 2 cm.
I consulted another urologist in the northern part of Taiwan, who mentioned that considering the shorter side of 1.9 cm, the stone appears to be somewhat loose and could potentially be treated with SWL, especially since the SWL technology is more advanced in the north.
Since both hospitals are military hospitals, I would like to know the recommended treatment options for a 2.2 cm kidney stone in private hospitals.
Additionally, as a military personnel, SWL and PCNL are free at military hospitals; could you provide an estimate of the costs for SWL and PCNL if I were to seek treatment at a private hospital for this 2.2 cm stone?

A-Mao, 40~49 year old female. Ask Date: 2017/03/31

Dr. Xu Wencang reply Urology

You can come to the outpatient clinic for further evaluation.
PCNL is a more complex procedure; I perform it regularly, but not every physician is familiar with it and may hesitate.
There is also the option of using a flexible ureteroscope, which can be discussed further with the physician.

Reply Date: 2017/03/31

More Info

When managing a 2.2 cm kidney stone, the choice between Extracorporeal Shock Wave Lithotripsy (SWL) and Percutaneous Nephrolithotomy (PCNL) is crucial and depends on several factors, including the size, location, and composition of the stone, as well as the patient's overall health and preferences.

Treatment Options
1. Extracorporeal Shock Wave Lithotripsy (SWL):
- Indications: SWL is typically indicated for stones that are less than 2 cm in size. It uses shock waves to break the stone into smaller fragments that can be passed through the urinary tract.

- Considerations: For a stone measuring 2.2 cm, there is a risk that SWL may not be effective, especially if the stone is dense or located in a position that makes it difficult to fragment effectively. The concern about potential obstruction of the urinary tract due to stone fragments is valid, particularly with larger stones.

- Cost: In a civilian hospital, the cost of SWL can vary widely, but it generally ranges from $5,000 to $15,000 depending on the facility and whether additional imaging or follow-up treatments are required.

2. Percutaneous Nephrolithotomy (PCNL):
- Indications: PCNL is recommended for larger stones (typically greater than 2 cm) or for stones that are difficult to treat with SWL. This minimally invasive procedure involves creating a small incision in the back to remove the stone directly.

- Considerations: PCNL is more invasive than SWL but is often more effective for larger stones. It has a higher success rate in completely removing the stone and is less likely to result in residual fragments that could cause future complications.

- Cost: The cost for PCNL in a civilian hospital can also vary, generally ranging from $10,000 to $25,000, depending on the complexity of the case and the length of hospital stay required.

Recommendations
Given the size of your kidney stone (2.2 cm), it is advisable to consider PCNL as the primary treatment option, especially since the urologist in the southern region has indicated that SWL could lead to complications such as complete obstruction. The northern urologist's opinion that SWL could be attempted may be based on the stone's characteristics, but the risk of complications should not be underestimated.

Follow-Up and Monitoring
Regardless of the treatment chosen, follow-up care is essential. After either procedure, regular imaging (such as ultrasound or CT scans) and urine tests will be necessary to ensure that the stone has been adequately treated and to monitor for any potential complications.

Conclusion
In summary, while both SWL and PCNL are viable options for treating kidney stones, the size and characteristics of your stone suggest that PCNL may be the more effective and safer choice. It is also important to discuss with your healthcare provider the potential costs involved in civilian hospitals, as well as the benefits of receiving treatment in a military facility where costs may be covered. Always weigh the risks and benefits of each treatment option and consider seeking a second opinion if you have any doubts.

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