Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter <15 mm: A 3-year open-label prospective study

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Abstract

Aim:

The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm.

Materials and Methods:

This was an open-label prospective study that included a total of 80 cases underwent mini-perc ( n = 40) and RIRS ( n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software.

Results:

Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group.

Conclusions:

Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi.

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Most cited references 24

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Complications in percutaneous nephrolithotomy.

Maurice Stephan Michel, Lutz Trojan, Jens Jochen Rassweiler (2007)

This review focuses on a step-by-step approach to percutaneous nephrolithotomy (PNL) and its complications and management. Based on institutional and personal experience with >1000 patients treated by PNL, we reviewed the literature (Pubmed search) focusing on technique, type, and incidence of complications of the procedure. Complications during or after PNL may be present with an overall complication rate of up to 83%, including extravasation (7.2%), transfusion (11.2-17.5%), and fever (21.0-32.1%), whereas major complications, such as septicaemia (0.3-4.7%) and colonic (0.2-0.8%) or pleural injury (0.0-3.1%) are rare. Comorbidity (i.e., renal insufficiency, diabetes, gross obesity, pulmonary disease) increases the risk of complications. Most complications (i.e., bleeding, extravasation, fever) can be managed conservatively or minimally invasively (i.e., pleural drain, superselective renal embolisation) if recognised early. The most important consideration for achieving consistently successful outcomes in PNL with minimal major complications is the correct selection of patients. A well-standardised technique and postoperative follow-up are mandatory for early detection of complications.

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Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results.

D M Albala, D Assimos, R Clayman … (2001)

The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.

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Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study.

Michael Grasso, , J J M C H de la Rosette … (2011)

The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November 2007-December 2009) were eligible for inclusion. PCNL procedures were performed according to local clinical guidelines and practices. Nephrostomy tract dilation was performed using balloon dilation, metal telescopic dilation, or Amplatz serial dilation. Hematologic complications assessed included bleeding rates, transfusion rates, and preoperative and postoperative hematocrit values. The median operating time with balloon dilation (n=2277) was significantly longer than with telescopic/serial dilation (n=3260) at 94.0 vs 60.0 minutes, respectively (P<0.0001). In the balloon dilation group, there was significantly more bleeding (9.4% vs 6.7%, respectively; P<0.0001) and more transfusions (7.0% vs 4.9%, respectively; P=0.001) compared with the telescopic/serial dilator group. Univariate analysis showed that the probability of bleeding complications was higher with balloon vs telescopic/serial dilation (odds ratio [OR] 1.75; P=0.0001) and larger sheath size (OR 1.42; P=0.0001). By multivariate analysis, sheath size but not dilation method was predictive of bleeding complications. Other significant predictive factors included operating time, stone load, and caseload. This study shows that in PCNL, factors that are associated with bleeding/transfusion include sheath size, operating time, stone load, and caseload.

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Author and article information

Journal

Journal ID (nlm-ta): Urol Ann

Journal ID (iso-abbrev): Urol Ann

Journal ID (publisher-id): UA

Title: Urology Annals

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0974-7796

ISSN (Electronic): 0974-7834

Publication date (Print): Apr-Jun 2018

Volume: 10

Issue: 2

Pages: 165-169

Affiliations

[1]Department of Urology, Dr. D.Y. Patil Medical College, Pune, Maharashtra, India

Author notes

Address for correspondence: Dr. Abhirudra Mulay, Department of Urology, Dr. D.Y Patil Medical College, Sant. Tukaram Nagar, Pimpri, Pune, Maharashtra, India. E-mail: dr_abhirudra@ 123456yahoo.co.in

Article

Publisher ID: UA-10-165

DOI: 10.4103/UA.UA_156_17

PMC ID: 5907325

SO-VID: 6ec0fbc0-9498-4005-ba6c-43027b901a91

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter <15 mm: A 3-year open-label prospective study

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Abstract

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Materials and Methods:

Results:

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 24

Complications in percutaneous nephrolithotomy.

Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results.

Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study.

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