32
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx.

          Materials and Methods

          Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups.

          Results

          Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4±13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status.

          Conclusions

          RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

          Related collections

          Most cited references 13

          • Record: found
          • Abstract: found
          • Article: not found

          Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis.

          Study Type--Therapy (case control). Level of Evidence 3b. What's known on the subject? and What does the study add? Recently European Association of Urology 2011 guidelines on urolithiasis recommended retrograde intrarenal surgery as the second-line therapy for the treatment of kidney stones <10 mm in diameter. This study shows that retrograde intrarenal surgery may be an alternative therapy to percutaneous nephrolithotomy, with acceptable efficacy and low morbidity for 2-4 cm stones. • Currently, the indications for retrograde intrarenal surgery (RIRS) have been extended due to recent improvements in endoscopic technology. In this study, we compare the outcomes of percutaneous nephrolithotomy (PCNL) and RIRS in the treatment of 2-4 cm kidney stones. • Between September 2008 and January 2011, 34 patients who had renal stones ranging from 2 to 4 cm in diameter were treated with RIRS. The outcomes of these patients were compared with patients who underwent PCNL using matched-pair analysis (1:1 scenario). • The matching parameters were the size, number and location of the stones as well as age, gender, body mass index, solitary kidney, degree of hydronephrosis, presence of previous shock wave lithotripsy and open surgery. • Data were analysed using Fisher's exact test, Student's t test and the Mann-Whitney U test. • Stone-free rates after one session were 73.5% and 91.2% for RIRS and PCNL respectively (P= 0.05). Stone-free rate in the RIRS group improved to 88.2% after the second procedure. • Mean operation duration was 58.2 (±) 13.4 min in the RIRS group but 38.7 (±) 11.6 min in the PCNL group (P < 0.0001). Blood transfusions were required in two patients in the PCNL group. • Overall complication rates in the PCNL group were higher, but the differences were not statistically significant. Hospitalization time was significantly shorter in the RIRS group (30.0 + 37.4 vs 61.4 + 34.0 h, respectively; P < 0.001). • Satisfactory outcomes can be achieved with multi-session RIRS in the treatment of 2-4 cm renal stones. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm.

            To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for 15 to 20 mm lower-pole (LP) renal calculi by evaluating stone-free rates and associated complications. The records of 79 patients who underwent either PCNL (n=42) or RIRS (n=37) by standard techniques for 15 to 20 mm LP renal calculi were reviewed retrospectively. In the PCNL group, the stone-free rate was 92.8% (39/42 patients); this rate increased to 97.6% after a second intervention (shockwave lithotripsy in one and RIRS in one). After a single RIRS procedure, 33 of 37 (89.2%) patients were completely stone free. Two patients needed an additional procedure (rigid ureteroscopy in one and RIRS in one), after which they were all completely stone free, resulting in an overall success rate of 94.6%. Two patients had asymptomatic residual fragments <7 mm in the LP of the kidney, and these patients had been followed with ultrasonography of the kidney. For complications, there were minimal differences in both procedures, except for hemorrhage (necessitated transfusion) in three patients who were treated with PCNL. The overall stone-free rates and complication rates for PCNL were higher, but the differences were not statistically significant. Operative time was significantly longer in the RIRS group, and postoperative hospital stay was significantly longer in PCNL group. PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Seoul National University Renal Stone Complexity Score for Predicting Stone-Free Rate after Percutaneous Nephrolithotomy

              Objectives Currently, no standardized method is available to predict success rate after percutaneous nephrolithotomy. We devised and validated the Seoul National University Renal Stone Complexity (S-ReSC) scoring system for predicting the stone-free rate after single-tract percutaneous nephrolithotomy (sPCNL). Patients and Methods The data of 155 consecutive patients who underwent sPCNL were retrospectively analyzed. Preoperative computed tomography images were reviewed. The S-ReSC score was assigned from 1 to 9 based on the number of sites involved in the renal pelvis (#1), superior and inferior major calyceal groups (#2–3), and anterior and posterior minor calyceal groups of the superior (#4–5), middle (#6–7), and inferior calyx (#8–9). The inter- and intra-observer agreements were accessed using the weighted kappa (κ). The stone-free rate and complication rate were evaluated according to the S-ReSC score. The predictive accuracy of the S-ReSC score was assessed using the area under the receiver operating characteristic curve (AUC). Results The overall SFR was 72.3%. The mean S-ReSC score was 3.15±2.1. The weighted kappas for the inter- and intra-observer agreements were 0.832 and 0.982, respectively. The SFRs in low (1 and 2), medium (3 and 4), and high (5 or higher) S-ReSC scores were 96.0%, 69.0%, and 28.9%, respectively (p<0.001). The predictive accuracy was very high (AUC 0.860). After adjusting for other variables, the S-ReSC score was still a significant predictor of the SFR by multiple logistic regression. The complication rates were increased to low (18.7%), medium (28.6%), and high (34.2%) (p = 0.166). Conclusions The S-ReSC scoring system is easy to use and reproducible. This score accurately predicts the stone-free rate after sPCNL. Furthermore, this score represents the complexity of surgery.
                Bookmark

                Author and article information

                Journal
                Korean J Urol
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                July 2015
                02 July 2015
                : 56
                : 7
                : 525-532
                Affiliations
                Department of Urology, Seoul National University Hospital, Seoul, Korea.
                [1 ]Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
                Author notes
                Corresponding Author: Seung-June Oh. Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. TEL: +82-2-2072-2406, FAX: +82-2-742-4665, sjo@ 123456snu.ac.kr
                Article
                10.4111/kju.2015.56.7.525
                4500810
                © The Korean Urological Association, 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funding
                Funded by: Seoul National University Hospital
                Award ID: 04-2012-0260
                Categories
                Original Article
                Endourology/Urolithiasis

                Urology

                nephrolithiasis, renal surgery, ureterorenoscopy

                Comments

                Comment on this article

                Similar content 168

                Cited by 7

                Most referenced authors 119