Vol. 7, Issue 2, Part A (2025)

Background: The optimal management of renal stones less than 1.5 cm remains debated, with extracorporeal shock wave lithotripsy (ESWL) and flexible Ureterorenoscopy (URS) being the most commonly employed minimally invasive modalities where in This study aimed to compare the efficacy, safety, cost-effectiveness, and patient-centered outcomes of ESWL and flexible URS in adult patients with small renal stones,
Methods: In this single-center prospective cohort study, 120 adult patients with renal stones ≤1.5 cm were randomized to receive either ESWL (N=60) or flexible URS (N=60). Baseline demographics, stone characteristics, and clinical history were recorded additionally the primary outcome was the stone-free rate at 3 months post-treatment also were Secondary outcomes included procedure duration, complication rates (Clavien-Dindo classification), retreatment and auxiliary procedure rates, inflammatory markers (CRP, WBC), cost analysis, quality of life (SF-36), and patient satisfaction. Statistical analysis was performed using t-tests, chi-square tests, and multivariate regression as appropriate, the
Results: which found in this study were The stone-free rate at 3 months was significantly higher in the URS group (86.7%) compared to the ESWL group (63.3%; P=0.003) and Retreatment rates were higher in the ESWL group (33.3% vs. 8.3%; p<0.001), Procedure time and hospital stay were shorter for ESWL (35±8 minutes; 0.5±0.2 days) than URS (65±12 minutes; 1.2±0.6 days; both p<0.001) in addition to Complication rates were low and similar between groups, finally ESWL was more cost-effective, with significantly lower hospital costs also we found Both groups showed significant improvement in quality of life and high patient satisfaction. URS outcomes were less affected by stone size and density. In summary, Flexible URS provides higher stone-free rates and lower retreatment needs than ESWL for renal stones ≤ 1.5 cm, particularly for larger or denser stones, and about ESWL remains a less invasive, more cost-effective option for selected patients.