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Tang QL, Liang P, Ding YF, Zhou XZ, Tao RZ. Comparative efficacy between retrograde intrarenal surgery with vacuum-assisted ureteral access sheath and minimally invasive percutaneous nephrolithotomy for 1-2 cm infectious upper ureteral stones: a prospective, randomized controlled study. Front Surg 2023; 10:1200717. [PMID: 37483661 PMCID: PMC10360123 DOI: 10.3389/fsurg.2023.1200717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To observe the efficacy and safety of retrograde intrarenal surgery combined with vacuum-assisted ureteral access sheath (V-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 1-2 cm infectious upper ureteral stone. Patients and methods A total of 173 patients with 1-2 cm infectious upper ureteral stone were prospectively randomized into two groups. Eighty-six in the V-UAS group and 87 cases as control in the MPCNL group. The SFRs at different times (Postoperative 1 day, 2nd week and 4th week) was considered as the primary outcome of the study. The secondary end points were operative time, postoperative hospital stay and operative complications. Results There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that the SFR at postoperative 1 day in the V-UAS group was significantly lower than that in the MPCNL group (73.2% vs. 86.2%, P = 0.034). However, there was no statistical significance between two groups in SFRs during postoperative 2 weeks and 4 weeks (All P > 0.05). The levels of WBC, CRP and PCT were all significant lower in the V-UAS group than those in the MPCNL group at the postoperative 24 h and 48 h (all P < 0.05). Postoperative complications included fever (≥38.5°C), bleeding, pain and urosepsis. In terms of the rates of fever, pain and urosepsis, MPCNL group were all significantly higher than those in the V-UAS group (10.3 vs. 2.4%, P = 0.031; 14.9 vs. 2.4%, P = 0.003; 4.6 vs. 0.0%, P = 0.044; respectively). No significant difference was found between two groups in bleeding. Meanwhile, postoperative hospital stay in the V-UAS group was more shorten than that in the MPCNL group (3.7 vs. 5.9 days, P < 0.001). Conclusions Our study showed that RIRS with V-UAS, a new partnership to treat 1-2 cm infectious upper ureteral stones, was satisfying as it achieved a high SFR rate and a low rate of infectious complications. This method was safe and reproducible in clinical practice.
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Affiliation(s)
- Qing-lai Tang
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Ping Liang
- Department of Hepatobiliary Surgery, The Second Hospital of Nanjing, Nanjing, China
| | - Ye-fei Ding
- Department of Urology, Liaocheng People’s Hospital, Liaocheng, China
| | - Xing-zhu Zhou
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Rong-zhen Tao
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
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Xu ZH, Du GY, Zhao YJ, Wang HY, Chen GJ, Tao C, Yan X. Single-center experience of micro-perc in the treatment of children with 1.0-2.0 cm sized kidney stones in the Galdakao-modified supine Valdivia position. World J Urol 2023; 41:837-841. [PMID: 36749393 DOI: 10.1007/s00345-023-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE We aimed to explore the applicability and safety of micro-percutaneous nephrolithotomy (micro-perc) in the treatment of children with kidney stones in the Galdakao-modified supine Valdivia (GMSV) position under the guidance of whole-course ultrasound. MATERIALS AND METHODS Patients were aged < 18 years in the GMSV position who underwent micro-perc for kidney stones under ultrasound guidance between August 2020 and May 2022 at our institution were reviewed retrospectively. RESULTS A total of 23 patients, 15 males and 8 females, received micro-perc. The average stone size was 1.6 cm (range 1.1-2.0 cm). Among them, 12 patients had left kidney stones, 10 patients had right kidney stones, and 1 patient had bilateral kidney stones. The mean operative time was 55.3 min (range 35-86 min). The mean hospital stay was 2.9 days (range 2-4 days). The mean hemoglobin decrease was 1.7 g/L (range 0.9-3.2 g/L). A total of 17 patients had complete stone clearance at 48 h postoperatively. A total of 22 patients had complete stone clearance at 2 weeks postoperatively. CONCLUSION Our results demonstrate that micro-perc under ultrasound guidance is a safe and effective method for the treatment of children with kidney stones in the GMSV position. Further research is warranted to confirm these results.
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Affiliation(s)
- Zi-Hao Xu
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Geng-Yu Du
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Yi-Jun Zhao
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Heng-You Wang
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Guang-Jie Chen
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Chang Tao
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China
| | - Xiang Yan
- Department of Urology, Pediatric Urolith Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China.
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Comparison Between Percutaneous Nephrolithotomy and Retrograde Flexible Nephrolithotripsy in Obese Patients with 2 - 4 cm Renal Stones. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-132180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Nowadays, because of remarkable advancements in retrograde intrarenal surgery (RIRS), modest attention toward this procedure as the second or alternative choice for renal stones treatment has been drawn. Objectives: In the present study, we compared RIRS and percutaneous nephrolithotomy (PCNL) outcomes in treating obese patients with 2 - 4 cm renal stones. Methods: Eighty-two patients who underwent PCNL (n = 40) and RIRS (n = 42) between June 2015 and December 2018 at the Department of Urology of Sina Hospital were enrolled in our retrospective cohort study. Results: After the first surgery session, stone-free rates for the RIRS group were 92.9% and for the PCNL group was 95% (P value = 0.52). The mean operation time for the RIRS and PCNL groups were 71.6 ± 11 and 93.3 ± 12.2, respectively (P < 0.001). The hospitalization stay for all of the PCNL group was more than 1 day (mean = 2.5 days); however, that for the majority of the RIRS group was less than 1 day (P < 0.001). The analgesic use in the RIRS group was significantly lower than in the PCNL group (9.0 ± 5.5, 61.8 ± 13.6, respectively; P < 0.001). The overall complication rates were higher in the RIRS group. However, none of them were statically significant (P > 0.05). Conclusions: According to satisfactory outcomes obtained in the RIRS groups, it can be concluded that RIRS can be applied as an alternative or even the first choice in obese patients with 2 - 4 cm renal stones.
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Gui H, Wang H, Kaushik D, Rodriguez R, Wang Z. Mini-Percutaneous Nephrolithotomy With an Endoscopic Surgical Monitoring System for the Management of Renal Stones: A Retrospective Evaluation. Front Surg 2022; 9:773270. [PMID: 35898587 PMCID: PMC9309435 DOI: 10.3389/fsurg.2022.773270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo compare the outcomes and postoperative quality of life of patients with renal calculi who underwent standard percutaneous nephrolithotomy (sPNL), mini-invasive percutaneous nephrolithotomy (mPNL) or mPNL with an endoscopic surgical monitoring system (ESMS) using a retrospective clinical trial.MethodsEighty-six adult patients with renal stones who were treated with sPNL were retrospectively compared to ninety-two patients who were treated with mPNL between July 2014 and December 2017. Next, further studies were retrospectively conducted using a matched paired method. The ninety-two patients treated with mPNL were divided into two groups based on whether the endoscopic surgical monitoring system (ESMS) was used (ESMS-mPNL vs. non-ESMS-mPNL). The ESMS used strain gauge transducers to measure the inflow and outflow of irrigation solution. Bleeding and fluid absorption during endoscopic surgery could be accurately calculated by computer program in ESMS.ResultsThe fluoroscopy time, complication rate, stone-free status and clinically insignificant residual fragment (CIRF) rate were not significantly different between the two groups (sPNL vs. mPNL). The mPNL group had a significantly longer operation time than the sPNL group, and the mPNL group exhibited a markedly reduced 12-h postoperative visual analogue pain scale (VAS) score, mean hospitalization time, and return to work time, had slightly reduced haemoglobin loss, and underwent more tubeless operations. Moreover, among the 92 patients who underwent mPNL, the operation time (P = 0.090), complication rate (P = 0.996), stone-free status (P = 0.731), CIRF rates (P = 0.125) and number of tubeless operations (P = 0.760) were not significantly different between the two subgroups (non-ESMS-mPNL vs. ESMS-mPNL); however, the patients in the ESMS-mPNL group had significantly longer irrigation times than those in the non-ESMS-mPNL subgroup, along with marked reductions in irrigation fluid, blood loss, haemoglobin loss, 12 h postoperative VAS score, mean hospitalization time, and return to work time.ConclusionsmPNL is less painful than sPNL in patients undergoing treatment for 20–40 mm renal stones. Similar stone-free rates were achieved by the two procedures, but mPNL was superior to sPNL in terms of blood loss, discomfort, hospitalization time and return to work time. We think that ESMS-mPNL is less painful for patients and more efficacious than non-ESMS-mPNL, and ESMS-mPNL achieves a stone-free rate that is similar to non-ESMS-mPNL in patients receiving treatment for 20–40 mm kidney stones.
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Affiliation(s)
- Huiming Gui
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Hanzhang Wang
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TXUnited States
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TXUnited States
| | - Zhiping Wang
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
- Correspondence: Zhiping Wang
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Sebaey A, Taleb AA, Elbashir S, Gomaa R, Elshazli A, Saber W. Flexible ureterorenoscopy (RIRS) vs. Mini- percutaneous nephrolithotomy (MINI-PCNL) for renal stones 20–30 mm a prospective randomized study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm.
Methods
A prospective randomized study of 70 patients who presented to the urology department with calyceal or renal pelvic stone of 20–30 mm between September 2017 and September 2019. Patients were randomly divided into two groups, Group A (Mini PCNL) consists of 35 patients who were treated with mini PCNL and Group B (RIRS) consists of 35 patients who were Achieving success of the technique was considered when the patient is stone-free or has radiologically insignificant residual fragments < 4 mm.
Results
The demographic data in this study were comparable in both groups. The stone size was 20.43 ± 2.2 mm in group A & 20.5 ± 2.1 in group B, with no statistical significance. Meanwhile, the operative time in group A was 59.71 ± 19.44 min and in group B was 80.43 ± 14.79 min with statistical significance difference (p value < 0.001), while Fluoroscopy time had a mean of 8.11 ± 2.05 min in group A & 5.8 ± 1.98 min in group B with statistically significant diffrence (p value < 0.001). The stone free rate (SFR) was 88.6% in mini PCNL and 82.9% in RIRS with no statistically significant difference (p value: 0.5).
Conclusion
RIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini-PCNL has more operative and postoperative complications. A multicenter studies with larger numbers of patients will be more effective to confirm these results.
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Zhu L, Wang Z, Zhou Y, Gou L, Huang Y, Zheng X. Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis. BMC Urol 2021; 21:158. [PMID: 34781950 PMCID: PMC8591951 DOI: 10.1186/s12894-021-00925-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/10/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuum-assisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis. METHODS PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated March 2021) were used to search for studies assessing the effect of vacuum-assisted sheaths in patients who underwent MPCNL. The search strategy and study selection processes were implemented in accordance with the PRISMA statement. RESULT Three randomized controlled trials and two case-controlled trials that satisfied the inclusion criteria were enrolled in this meta-analysis. Overall, the stone-free rate (SFR) in patients who underwent vacuum-assisted sheaths was significantly higher than that in patients who underwent conventional sheaths (RR 1.23, 95% CI 1.04, 1.46, P = 0.02), with significant heterogeneity among the studies (I2 = 72%, P = 0.03). In terms of the outcome of complications, vacuum-assisted sheath could bring a benefit to the postoperative infection rate (RR 0.48, 95% CI 0.33, 0.70, P < 0.00001) with insignificant heterogeneity among the studies (I2 = 0%, P = 0.68). There was no significant difference in the blood transfusion rate (RR 0.35, 95% CI 0.07, 1.73, P = 0.17), with significant heterogeneity (I2 = 66%, P = 0.35). Three studies contained operative time data, and the results indicated that the vacuum-assisted sheath led to a shorter operative time (MD = - 15.74; 95% CI - 1944, - 12.04, P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.91). CONCLUSION The application of a vacuum-assisted sheath in MPCNL improves the safety and efficiency compared to the conventional sheath. A vacuum-assisted sheath significantly increases the SFR while reducing operative time and postoperative infection.
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Affiliation(s)
- Ling Zhu
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenghao Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Liping Gou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaofeng Zheng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China.
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Grosso AA, Sessa F, Campi R, Viola L, Polverino P, Crisci A, Salvi M, Liatsikos E, Feu OA, DI Maida F, Tellini R, Traxer O, Cocci A, Mari A, Fiori C, Porpiglia F, Carini M, Tuccio A, Minervini A. Intraoperative and postoperative surgical complications after ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy: a systematic review. Minerva Urol Nephrol 2021; 73:309-332. [PMID: 33887891 DOI: 10.23736/s2724-6051.21.04294-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Retrograde ureteroscopy (URS), intra-renal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) represent routine interventions for the treatment of ureteral and renal stones, although at times associated with serious adverse events. Of note, the evidence on perioperative complications after these procedures remains sparse and controversial. Moreover, there is a lack of standardized reporting of adverse events using uniform systems. The aim of the present study was to systematically review of the available evidence on URS/RIRS and PCNL for the surgical treatment of urinary stone, assessing the incidence of intra- and postoperative events, classified according to the modified Clavien-Dindo scale. EVIDENCE ACQUISITION A systematic review of the literature was performed according to PRISMA recommendations and was conducted on intra- and postoperative complications, as well as on their management, following URS, RIRS and PCNL procedures, particularly focusing on major events. EVIDENCE SYNTHESIS Overall, 26 studies (13 on URS/RIRS and 11 on PCNL) met the inclusion criteria and were evaluated. The highest intraoperative complication rate was 11.5% and 8.5% for RIRS and PCNL, respectively. Major complication rate following URS/RIRS and PCNL ranged between 0.3-31.7% and 2-17.1%, respectively. The most frequent adverse events were obstructive pyelonephritis or urinary leakage requiring the placement of a double J stent or a drainage. Among PCNLs series, life-threatening adverse events have also been reported, including bleeding requiring renal angioembolization and urothorax. CONCLUSIONS Despite the inclusion of series using a standardized reporting system, the complication rate after URS/RIRS/PCNL remains extensively heterogeneous in the literature; in addition, a non-negligible proportion of studies did not characterize the adverse events nor report the actual management strategy to solve them. Future research is needed to standardize the classification and reporting of surgical complications after endourological procedures (taking into consideration the surgeon's experience and skills), aiming to improve patient counseling and potentially the strategy for their prevention.
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Affiliation(s)
- Antonio A Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Viola
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Paolo Polverino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Alfonso Crisci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Matteo Salvi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | | | | | - Fabrizio DI Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Olivier Traxer
- Service of Urology, Sorbonne University, Paris, France
- Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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Jiao B, Luo Z, Huang T, Zhang G, Yu J. A systematic review and meta-analysis of minimally invasive vs. standard percutaneous nephrolithotomy in the surgical management of renal stones. Exp Ther Med 2021; 21:213. [PMID: 33574911 PMCID: PMC7818531 DOI: 10.3892/etm.2021.9645] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/24/2020] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to assess current evidence on the effectiveness and safety of minimally invasive vs. standard percutaneous nephrolithotomy (PCNL) in the management of renal stones. A systematic search of electronic databases, which included PubMed, EMBASE and the Cochrane Library up to May 2019 was performed. Using Review Manager statistical software (version 5.3), primary outcomes, including stone-free rates (SFRs), were evaluated. Meanwhile, analysis was also performed to compare secondary outcomes, such as peri- and postoperative complications and operative data. Fourteen studies involving 1,611 patients with renal stones were analyzed based on the inclusion criteria. On the basis of the present analysis, mini percutaneous nephrolithotomy (MPCNL) was proven to have non-inferior clinical efficacy with respect to the SFR compared with PCNL [odds ratio (OR)=1.10; 95% confidence interval (CI), 0.84-1.44; P=0.48]. In addition, the meta-analysis showed that MPCNL had a significantly lower hemoglobin decrease [mean difference (MD)=-0.68; 95% CI, -1.05 to -0.31; P=0.0003] and fewer blood transfusions (OR=0.36; 95% CI, 0.18-0.71; P=0.003) compared with PCNL. Moreover, the MPCNL group had a shorter inpatient stay (MD=-0.81; 95% CI, -1.55 to -0.08; P=0.03) compared with the PCNL group. However, the overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with PCNL. The present meta-analysis indicates that MPCNL is an effective method for treating renal stones. Compared with PCNL, MPCNL not only has similarly high SFRs but is also associated with less blood loss, fewer blood transfusions, more favorable recovery time and shorter inpatient stays. However, the findings of the present study should be further confirmed by well-designed prospective randomized controlled trials with a larger patient series.
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Affiliation(s)
- Binbin Jiao
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Zhenkai Luo
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China.,Medical College, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Tao Huang
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China.,Medical College, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China.,Medical College, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Jiang Yu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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Jiao B, Luo Z, Xu X, Zhang M, Zhang G. Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in surgical management of upper urinary stones - A systematic review with meta-analysis. Int J Surg 2019; 71:1-11. [PMID: 31521837 DOI: 10.1016/j.ijsu.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to retrospectively assess the efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) in the management of upper urinary stones. METHODS A comprehensive literature review of articles that investigated the efficacy and safety of MPCNL and RIRS was conducted by systematically searching PubMed, EMBASE, and Cochrane Library in March 2019. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. RESULTS Eight randomized controlled trials (RCTs) involving 725 patients with upper urinary stones were analysed based on the inclusion criteria. While MPCNL has a better clinical efficacy than RIRS with respect to the stone-free rate (SFR) [RR = 1.11, 95% CI (1.05-1.17), p = 0.0005], MPCNL has a higher incidence of haematoma [RR = 3.09, 95% CI (1.44-6.66), p = 0.004] and longer hospitalization time [MD = 0.89 day, 95% CI (0.07-1.72), p = 0.04]. In addition, no significant difference in operative time [MD = 2.46 min, 95% CI (-17.99 to 22.92), p = 0.81] and postoperative pain score [MD = 0.74, 95% CI (-0.45 to 1.94), p = 0.22] were observed between the two methods. Overall, the evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with RIRS. CONCLUSIONS Our data suggest that MPCNL is an effective method for treating upper urinary stones, especially lower calyceal stones that are 1-2 cm in size. Compared to RIRS, MPCNL is associated with a longer hospital stay time and a higher incidence of haematoma. In addition, both methods have proven to be safe. Nevertheless, the findings should be further confirmed through well-designed prospective RCTs with a larger patient series.
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Affiliation(s)
- Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Zhenkai Luo
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Xin Xu
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Meng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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11
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Jiang K, Chen H, Yu X, Chen Z, Ye Z, Yuan H. The "all-seeing needle" micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of ≤ 2 cm. Urolithiasis 2018; 47:201-206. [PMID: 29497768 DOI: 10.1007/s00240-018-1049-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
Abstract
The objectives of the study are to compare the safety and efficacy of "all-seeing needle" optical puncture system micro-percutaneous nephrolithotomy (micro-PCNL) and flexible ureterorenoscopy (FURS) for the treatment of lower calyceal stones of ≤ 2 cm and to determine the advantages and disadvantages of each. 116 patients in total with lower calyceal stones of ≤ 2 cm were randomly divided into two equal groups, "all-seeing needle" optical puncture system micro-PCNL and FURS. In both groups, holmium laser was utilized for lithotripsy. The perioperative parameters were compared between the two groups. Compared to the "all-seeing needle" micro-PCNL group, the mean operative time was significantly longer in the FURS group (P = 0.000). However, there was no significant difference between the two groups with respect to mean hemoglobin reduction (P = 0.087), complications (P = 0.731) and LOS (P = 0.856). The overall SFR of the "all-seeing needle" micro-PCNL group and FURS group was 84.5% (49/58) and 79.3% (46/58), respectively, without any significant difference between the groups (P = 0.469). For treating lower calyceal stones of ≤ 2 cm, the "all-seeing needle" micro-PCNL group had shorter operative time than FURS, while no significant differences between the two groups with respect to mean hemoglobin reduction, complications, LOS and SFR were found.
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Affiliation(s)
- Kehua Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei, China
| | - Hongbo Chen
- Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huixing Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Liu Y, AlSmadi J, Zhu W, Liu Y, Wu W, Fan J, Lan Y, Lam W, Zhong W, Zeng G. Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: a propensity score-matching study. World J Urol 2018; 36:955-961. [DOI: 10.1007/s00345-018-2197-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/19/2018] [Indexed: 12/23/2022] Open
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Gadzhiev N, Sergei B, Grigoryev V, Okhunov Z, Ganpule A, Pisarev A, Iskakov Y, Petrov S. Evaluation of the effect of Bernoulli maneuver on operative time during mini-percutaneous nephrolithotomy: A prospective randomized study. Investig Clin Urol 2017; 58:179-185. [PMID: 28480343 PMCID: PMC5419106 DOI: 10.4111/icu.2017.58.3.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/10/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the effect of 'Bernoulli maneuver' (bringing the access sheath to horizontal plane) on operative time and stone free rates in patients undergoing mini-percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS All consecutive patients with a solitary kidney stone undergoing a mini-PCNL between 2015 and 2016 were included into this study. Patients were randomized either to standard prone or control (C) group patients or to tilted prone with 'Bernoulli maneuver' group (B) patients. Pre-, intra-, and postoperative characteristics of these 2 groups were recorded and analyzed. RESULTS A total of 67 patients were included in the study. Of these, 40 patients were randomized to group C and 27 to group B. The mean (95% confidence limits) stone size (mm) in group C and B was 14 (13, 15) and 13 (11, 14), respectively (p=0.26). Nephroscopy time was shorter in Bernoulli group (35 minutes vs. 23 minutes, p=1.5·10-5, and Bayes factor BF10=2,340, and Cohen standardized effect size dst=1.2). The difference made it up 12 minutes (with 95% confidence interval from 8 to 18 minutes). There were no statistically significant differences between groups regarding white blood cell, creatinine level and stone-free status defined by computed tomography on the first postoperative day. CONCLUSIONS In our study the 'Bernoulli maneuver' led to a shorter nephroscopy time in mini-PCNL. This maneuver can significantly reduce nephroscopy time and save significant amount of operative time, especially in tertiary referral centers with high-volume mini-PCNL procedures.
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Affiliation(s)
- Nariman Gadzhiev
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Brovkin Sergei
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Vladislav Grigoryev
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Aleksei Pisarev
- The Saint-Petersburg State University clinic, Saint-Petersburg, Russia
| | | | - Sergei Petrov
- The Federal State Institute of Public Health 'The Nikiforov Russian Center of Emergency and Radiation Medicine', Saint-Petersburg, Russia
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Soliman T, Sherif H, Sebaey A, Mohey A, Elmohamady BN. Miniperc vs Shockwave Lithotripsy for Average-Sized, Radiopaque Lower Pole Calculi: A Prospective Randomized Study. J Endourol 2016; 35:896-901. [PMID: 27676117 DOI: 10.1089/end.2016.0259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: To detect safety and feasibility of miniperc and extracorporeal shockwave lithotripsy (SWL) for treatment of average-sized (1-2 cm), radiopaque lower pole calculi in a prospective randomized manner. Patients and Methods: In the period from January 2014 to June 2015, 150 patients were attached to this study with single lower pole radiopaque stone ranging from 10 to 20 mm. Patients were divided randomly into two groups using computer-generated randomization in an equal manner. First group patients were subjected to miniperc procedure, while second group patients underwent SWL. Patient's characters, stones' characters, fluoroscopic time, operative time, blood transfusion, hospital stay, retreatment, auxiliary procedure (AP), and complications using modified Clavien grading are tabulated and analyzed. Results: This study included two equal groups with 75 patients in each group. With regard to age (37.75 ± 11.25 vs 40.55 ± 10.55), body mass index (26.92 ± 2.26 vs 27.29 ± 2.87), and stone size (1.55 ± 0.28 vs 1.57 ± 0.26), there was no significant statistical difference in both groups. Stone-free rate (SFR) (76% vs 96%), operative time (44.81 ± 7.06 vs 93.37 ± 12.29 minutes), fluoroscopy time (53 ± 2.45 vs 180 ± 7.31 seconds), hospital stay (5.72 ± 1.01 vs 45.19 ± 8.48 hour), and blood transfusion were significantly more in the miniperc group. Retreatment rate (45.3% vs 2.7%) and AP (24% vs 4%) were significantly greater in the SWL group. Conclusion: SWL is less invasive than percutaneous stone removal, but it is also less effective for lower pole radiopaque calculi. Miniperc has better SFR and lower auxiliary and retreatment rates; however, it resulted in more drawbacks.
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Affiliation(s)
- Tarek Soliman
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hammouda Sherif
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Sebaey
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Mohey
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
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Ganpule A, Chhabra JS, Kore V, Mishra S, Sabnis R, Desai M. Factors predicting outcomes of micropercutaneous nephrolithotomy: results from a large single-centre experience. BJU Int 2015; 117:478-83. [DOI: 10.1111/bju.13263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arvind Ganpule
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
| | | | - Vinayak Kore
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
| | | | | | - Mahesh Desai
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
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Ölçücüoğlu E, Kasap Y, Ölçücüoğlu E, Şirin ME, Gazel E, Taştemur S, Odabas Ö. Micropercutaneous nephrolithotripsy: initial experience. Wideochir Inne Tech Maloinwazyjne 2015; 10:368-72. [PMID: 26649082 PMCID: PMC4653270 DOI: 10.5114/wiitm.2015.54223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/25/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For small renal calculi (< 2 cm) the currently available treatment options include extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and standard/mini percutaneous nephrolithotomy (PNL). A new method, microperc, has therefore been developed, in which a smaller tract size and smaller instruments were used. AIM To present our clinical experiences with micropercutaneous nephrolithotripsy (microperc) in the treatment of small renal calculi. MATERIAL AND METHODS We retrospectively evaluated patients with small renal calculi who underwent microperc between February and June 2013. A 4.8 Fr 'all-seeing needle' was used to achieve percutaneous renal access with the C-arm fluoroscopy guidance in the prone position. Holmium: YAG laser 272 µm fiber was used for stone fragmentation. RESULTS A total of 20 patients underwent the microperc procedure. The mean age of the patients was 46.5 ±13.8 years. The mean stone size was 13 ±3 mm. The stone-free rate (SFR) was 90% (18/20). Two patients had clinically significant residual fragments (≥ 4 mm). The mean operation and fluoroscopy times were 107.5 ±37 min and 45 ±40 s respectively. The mean postoperative drop in hemoglobin was 1.2 ±0.9 g/dl, and 1 patient required blood transfusion. The patients were discharged after an average hospitalization of 1.4 ±0.8 days. Two complications, urinary tract infection and blood loss requiring blood transfusion, were observed in 2 patients postoperatively. CONCLUSIONS We suggest that microperc should be considered for the treatment of small renal stones.
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Affiliation(s)
- Erkan Ölçücüoğlu
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Yusuf Kasap
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Esin Ölçücüoğlu
- Department of Radiology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Mehmet Emin Şirin
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Sedat Taştemur
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Öner Odabas
- Department of Urology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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Mini-percutaneous Nephrolithotomy vs Retrograde Intrarenal Surgery for Renal Stones Larger Than 10 mm: A Prospective Randomized Controlled Trial. Urology 2015; 86:873-7. [PMID: 26320082 DOI: 10.1016/j.urology.2015.08.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the management of renal stones >10 mm in a single session. METHODS Seventy patients presenting with renal stones >10 mm were randomized to a mini-PCNL or an RIRS group in a ratio of 1:1. Randomization was performed by a biostatistician and opened to the surgeon at the time of the patient's admission on the day before surgery. Patient and stone characteristics, perioperative outcomes, and complications were compared between the 2 groups. The primary end point of "stone-free" which was defined as no residual stone or stones <2 mm on computed tomography within 3 months postoperatively. RESULTS Thirty-five patients (mini-PCNL) and 33 (RIRS) were included in the final analysis. Mini-PCNL and RIRS had a stone-free rate of 85.7% and 97.0%, respectively (P = .199). Operation time (P = .148), hemoglobin decline (P = .323), and hospital stay (P = .728) were similar between the 2 groups. Pain visual analog score at 1 hour postoperatively (P = .029) and analgesic requirement (P = .050) were higher in the RIRS group. Two patients in the mini-PCNL group and 1 in the RIRS group had minor pelvic or ureter perforation. One patient in each of the 2 groups had hypertension and urinary tract infection. CONCLUSION Mini-PCNL and RIRS are safe and feasible surgical options to manage renal stones >10 mm. RIRS produced a slightly higher stone-free rate, but more immediate postoperative pain and higher analgesic requirement compared with mini-PCNL.
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Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis 2015; 43:563-70. [PMID: 26242465 DOI: 10.1007/s00240-015-0808-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
The aim of the study was to objectively analyze the outcomes for minimally invasive percutaneous nephrolithotomy (MPCNL) vs standard percutaneous nephrolithotomy (PCNL) by systematic review and meta-analysis of published data. A systematic literature review was performed in November 2014 using the PUBMED, EMBASE and Cochrane Library databases to identify relevant studies. Only comparative studies investigating MPCNL vs PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs). The analyzed outcomes were stone-free rate (SFR), blood loss, pain assessment, operative time, hospital stay and complications. We identified 8 trials with a total 749 patients. 353 patients were treated with MPCNL and 396 with PCNL. Meta-analysis of the data showed that there was no difference in SFR between MPCNL and PCNL (OR 1.06, 95% CI 0.71-1.58). Patients in the MPCNL group experienced less drop in hemoglobin (MD: -4.67 g/L, 95% CI -7.29 to -2.04), a lower incidence of blood transfusion (OR 0.18, 95% CI 0.06-0.54), less pain (visual analog score) (MD: -0.53, 95% CI -0.94 to -0.13) and shorter hospitalization (MD: -1.32 days, 95% CI -2.15 to -0.50). Operative time was longer in the MPCNL group (MD: 15.54 min, 95% CI 4.25-26.83). Postoperative fever and pyelocalyceal perforation did not differ between the groups (p = 0.38 and 0.44, respectively). Current evidence suggested that MPCNL was a safe and effective procedure with an SFR comparable to that of PCNL. MPCNL resulted in less bleeding, fewer transfusion, less pain and shorter hospitalization. Well-designed multicentric/international randomized, controlled trials are still needed.
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20
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Zheng C, Yang H, Luo J, Xiong B, Wang H, Jiang Q. Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis. Urolithiasis 2015. [PMID: 26211003 DOI: 10.1007/s00240-015-0799-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1-2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature Database were researched and hand-searched for relevant congress abstracts and journals about RIRS and ESWL for the treatment for 1- to 2-cm renal stones. The retrieval time ended in September 2014. The related trials met the inclusion criteria were included in the meta-analysis. Two reviewers independently assessed the quality of all included studies, and meta-analysis was performed with RevMan 5.2. Seven literatures were retrieved, including 983 patients. The meta-analysis results showed that, compared to RIRS group, the patients in ESWL group had the following features:(1) the stone-free rate [relative risk (RR) 0.86; 95% confidence interval (CI) 0.77-0.95, P = 0.005] was significantly different between two groups; (2) The retreatment rate of RIRS group was lower (RR 8.12; 95% CI 4.77-13.83, P < 0.00); (3) The complications were not significantly different between two groups (Grade I RR 1.06; 95% CI 0.67-1.69, P = 0.80; Grade II RR 0.75; 95% CI 0.29-1.91, P = 0.54; Grade III RR 0.86; 95% CI 0.26-2.86, P = 0.80). Compared to ESWL, our results showed that RIRS provided significantly higher stone-free rate and lower retreatment rate and without increase in the incidence of complications. However, further randomized trials are needed to confirm these findings.
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Affiliation(s)
- Changjian Zheng
- Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China.
| | - Hongmei Yang
- Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China.
| | - Jun Luo
- Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China
| | - Bo Xiong
- Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China
| | - Hongzhi Wang
- Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China
| | - Qing Jiang
- Department of Urology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China
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Kumar A, Kumar N, Vasudeva P, Kumar R, Jha SK, Singh H. A Single Center Experience Comparing Miniperc and Shockwave Lithotripsy for Treatment of Radiopaque 1–2 cm Lower Caliceal Renal Calculi in Children: A Prospective Randomized Study. J Endourol 2015; 29:805-9. [DOI: 10.1089/end.2015.0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
| | - Rohit Kumar
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sanjeev Kumar Jha
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
| | - Harbinder Singh
- Department of Urology and Renal Transplant, VMMC and Safdarjung Hospital, New Delhi, India
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Bhattu AS, Mishra S, Ganpule A, Jagtap J, Vijaykumar M, Sabnis RB, Desai M. Outcomes in a large series of minipercs: analysis of consecutive 318 patients. J Endourol 2014; 29:283-7. [PMID: 25177918 DOI: 10.1089/end.2014.0290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to evaluate the outcomes of miniperc at our center. PATIENTS AND METHODS This is a retrospective review of consecutive 318 minipercs done in a single tertiary urological center. The Miniperc system used was either Wolf (Richard Wolf) 14F with 20F Amplaz sheath or Storz (Karl Storz) nephroscope 12F with 15/18F sheath or 16.5/19.5F sheath. Data about the demography of patients, comorbidities, stone size, number and size of the tract, size of nephroscope, energy source used, total operative time, exit strategy, hospital stay, clearance of stones, total analgesic requirement, visual analogue pain score at 6 and 24 hours, hemoglobin drop and complications were analyzed by the chi-square test and analysis of variance test. RESULTS The average age of patients, stone size, operative time, hemoglobin drop and hospital stay were 41.9±17.0 years, 15.26±6.35 mm, 60±19 minutes,1.0±0.6 g/dL and 2.8±1 day, respectively. Complete clearance rate was 98.7%. Fourteen (4.4%) patients had Clavien-Dindo level 1 complications and 1 (0.31%) patient had Clavien-Dindo level 2 complications. The size of the stone treated by miniperc did not affect the hemoglobin drop (p-value=0.26) or hospital stay (p-value=0.924). There is no significant increase in hemoglobin drop (p-value=0.064) or hospital stay (p-value=0.627) with increasing number of miniperc tracts. An increase in operative time is associated with the increase in hemoglobin drop (p-value=0.041). Different energy sources did not significantly affect the operative time (p-value=0.184). Placement of only ureteral catheter is associated with less analgesic requirement (p-value=0.000). CONCLUSIONS Miniperc is a safe alternative to standard percutaneous nephrolithotomy. In carefully selected patients, the best exit strategy would be a tubeless procedure with ureteral catheter drainage.
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Affiliation(s)
- Amit Satish Bhattu
- Department of Urology, Muljibhai Patel Urological Hospital , Nadiad, India
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Ganpule AP, Bhattu AS, Desai M. PCNL in the twenty-first century: role of Microperc, Miniperc, and Ultraminiperc. World J Urol 2014; 33:235-40. [DOI: 10.1007/s00345-014-1415-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022] Open
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Long CJ, Srinivasan AK. Percutaneous nephrolithotomy and ureteroscopy in children: evolutions. Urol Clin North Am 2014; 42:1-17. [PMID: 25455168 DOI: 10.1016/j.ucl.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.
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Affiliation(s)
- Christopher J Long
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor, Wood Center, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Arun K Srinivasan
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor, Wood Center, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Kumar A, Kumar N, Vasudeva P, Kumar Jha S, Kumar R, Singh H. A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: a single center experience. J Urol 2014; 193:160-4. [PMID: 25066869 DOI: 10.1016/j.juro.2014.07.088] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for the treatment of 1 to 2 cm radiolucent lower calyceal renal calculi was done to evaluate the safety and efficacy of these procedures. MATERIALS AND METHODS Patients with a single 1 to 2 cm radiolucent lower calyceal renal stone who underwent treatment between January 2012 and May 2013 were included in study. They were randomized to shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Patient demographic profiles, success and re-treatment rates, auxiliary procedures and complications were analyzed. RESULTS A total of 45 patients were enrolled in each of the shock wave lithotripsy, retrograde intrarenal surgery and miniperc groups. Three, 2 and 4 patients, respectively, were excluded from final analysis due to a matrix stone diagnosis. Mean procedure and fluoroscopy times were significantly greater in the miniperc group than in the other groups. Hospital stay (3.1 days vs 3.1 hours and 1.3 days, p = 0.01) and the blood transfusion rate (13.3% vs 0% and 0%, p = 0.03) were significantly higher for miniperc vs shock wave lithotripsy and retrograde intrarenal surgery, respectively. The re-treatment rate (63.4% vs 2.1% and 2.2%, p <0.001) and the auxiliary procedure rate (20.2% vs 8.8% and 6.6%, p = 0.02) were significantly greater for shock wave lithotripsy than for retrograde intrarenal surgery and miniperc, respectively. The 3-month stone-free rate of shock wave lithotripsy, retrograde intrarenal surgery and miniperc was 73.8% (31 of 42 patients), 86.1% (37 of 43) and 95.1% (39 of 41), respectively (p = 0.01). CONCLUSIONS Miniperc and retrograde intrarenal surgery were more effective than shock wave lithotripsy to treat 1 to 2 cm radiolucent lower calyceal renal calculi in terms of a better stone-free rate, and lesser auxiliary and re-treatment rates. However, miniperc resulted in more complications, greater operative time and radiation exposure, and a longer hospital stay.
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Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
| | - Niraj Kumar
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Sanjeev Kumar Jha
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Rohit Kumar
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Harbinder Singh
- Department of Urology and Renal Transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
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Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 2013; 112:355-61. [DOI: 10.1111/bju.12164] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ravindra B. Sabnis
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
| | - Raguram Ganesamoni
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
| | - Amit Doshi
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
| | - Arvind P. Ganpule
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
| | - Jitendra Jagtap
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
| | - Mahesh R. Desai
- Department of Urology; Muljibhai Patel Urological Hospital; Nadiad; Gujarat; India
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