Percutaneous nephrolithotomy versus flexible ureteroscopy in terms of cost-effectiveness in patients with 10-30 mm renal stones

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2-4 cm

Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.

Comparison of serum Kim-1 and Miox levels in patients that underwent percutaneous nephrolithotomy and flexible ureterorenoscopy

OBJECTIVE

Percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) are common surgical methods in the treatment of kidney stones. Possible effects on kidneys are an important factor in determining the surgical procedure and the surgical method. In our study, kidney injury molecule-1 (KIM-1) and myo-inositol oxygenase (MIOX) were used to compare acute kidney injury in patients that underwent PNL and RIRS.

MATERIAL AND METHOD

Eighty patients aged 20-75, who underwent PNL or RIRS in our urology clinic between November 2018 and February 2020 were included in the study. In this prospective study, the demographic characteristics, stone size, operation time, preoperative and postoperative hemoglobin and biochemistry values of the patients were recorded. About 5 cc blood samples taken from the patients before the operation and at the fourth hour after the operation were centrifuged and kept at -80°C, and the KIM-1 and MIOX levels were measured in the biochemistry department.

RESULTS

There was no difference between the groups in terms of demographic data; however, the operation time and length of hospital stay were significantly longer in the PNL group. The mean increase in MIOX was 10.583 ± 9.73 and 7.501 ± 16.46 ng/ml in the PNL and RIRS groups, respectively. Although there was a statistically significant increase in both groups, this increase was greater in the PNL group. A significant increase was observed only in the PNL group in the postoperative period (p = 0.003).

DISCUSSION AND CONCLUSION

The findings of the study suggest that the PNL procedure causes more damage to the kidneys than RIRS.

Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones

OBJECTIVE

We aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management.

PATIENTS AND METHODS

Ninety pediatric patients with single or multiple renal stones 1-3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications.

RESULTS

There were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV-V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL.

CONCLUSIONS

Both RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10-30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.