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Aggarwal MK, Singh S, Singh V, Singh MK. Transperitoneal Laparoscopic Pyelolithotomy in Pelvic Ectopic Kidneys: Experience From a Northern Indian Tertiary Care Institution. Cureus 2024; 16:e65406. [PMID: 39184690 PMCID: PMC11344887 DOI: 10.7759/cureus.65406] [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] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction The ectopic pelvic kidneys have a higher likelihood of developing renal stones due to urinary stasis caused by the abnormal position of the renal pelvis, altered course of the ureter, and kidney malrotation. This retrospective study highlights the safety, efficacy, and feasibility of performing transperitoneal laparoscopic pyelolithotomy in cases of pelvic ectopic kidney. Methodology The 15 patients with ectopic pelvic kidneys and nephrolithiasis underwent laparoscopic pyelolithotomy. The kidney was exposed either by moving the bowel or using a trans-mesocolic approach. A surgical procedure was performed to remove stones from the renal pelvis using laparoscopic forceps. Following the placement of a double J stent, the incision in the renal pelvis was closed. The procedure was completed after the intraperitoneal drain was inserted. Results A total of 15 patients underwent the transperitoneal laparoscopic pyelolithotomy procedure, with a male-to-female ratio of 3:2. The average age of the patients was 41 (25-58) years, while the average size of the stones was 3.8 cm. Additionally, seven (46.6%) patients had the presence of caliceal stones in conjunction with the pelvic stone. Out of the 15 patients, some had stones on the left side (n = 9, 60%), while others had stones on the right side (n = 6, 40%). The operation with an average duration was 125 minutes with a range of (90-190). Fourteen (93.3%) patients were found to be free of stones. A patient required extracorporeal shock wave lithotripsy (ESWL) to address a small caliceal residual stone measuring 8 mm. After just one session of ESWL, this stone was completely cleared. All stones were successfully removed, resulting in a 100% stone-free rate. Conclusions Laparoscopic pyelolithotomy is a highly effective and efficient procedure for treating large and numerous stones in the ectopic pelvic kidney. This method has a significant level of efficiency in removing stones with limited consequences.
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Affiliation(s)
| | | | | | - Mukul K Singh
- Urology, King George's Medical University, Lucknow, IND
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2
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Erçil H, Karkin K, Vuruşkan E. Is laparoscopic pyelolithotomy an alternative to percutaneous nephrolithotomy for treatment of kidney stones larger than 2.5 cm in pediatric patients? Pediatr Surg Int 2023; 39:78. [PMID: 36627447 DOI: 10.1007/s00383-023-05367-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim was to compare laparoscopic pyelolithotomy and percutaneous nephrolithotomy in terms of efficacy and safety for the treatment of renal pelvis stones larger than 2.5 cm in pediatric patients. METHODS Our study consisted of two groups. Group 1 included 33 patients who underwent laparoscopic pyelolithotomy (LPL) between January 2013 and March 2022, and group 2 included 39 patients who underwent percutaneous nephrolithotomy (PCNL). The basic clinical parameters of the patients were recorded. Mean operation time, stone size, estimated blood loss, blood transfusion rate, postoperative hospital stay, stone-free rate, postoperative analgesia requirements, intraoperative complications, and early and late postoperative complications were compared between the two groups. RESULTS In our study, the mean age of the patients in groups 1 and 2 was 8.89 ± 1.58 years and 9.1 ± 1.85 years, respectively (p = 0.657). The mean stone size was 2.37 ± 0.38 cm in group 1 and 2.55 ± 0.45 cm in group 2 (p = 0.64). The mean operation time was 85.65 ± 20.55 min in group 1, while it was 76.11 ± 13.12 min in group 2 (p = 0.08). The stone-free rate was 100% in both groups. Intraoperative mean blood loss, need for postoperative analgesia, blood transfusion and intraoperative complication rates were significantly higher in the PCNL group (p < 0.01, p = 0.02, p < 0.01, p < 0.01, respectively). CONCLUSION Our results show that laparoscopic pyelolithotomy is a safe and effective method for pediatric patients with large kidney stones.
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Affiliation(s)
- Hakan Erçil
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
| | - Kadir Karkin
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey
| | - Ediz Vuruşkan
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey
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3
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Duarsa GWK, Tirtayasa PMW, Pramana IBP, Yudiana IW, Santosa KB, Oka AAG. Meta-Analysis of Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy as a Treatment of Large Kidney Stones. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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4
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Mantica G, Balzarini F, Chierigo F, Keller EX, Talso M, Emiliani E, Pietropaolo A, Papalia R, Scarpa RM, Terrone C, Esperto F. The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis. Minerva Urol Nephrol 2022; 74:169-177. [PMID: 35147384 DOI: 10.23736/s2724-6051.21.04587-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis is to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. EVIDENCE ACQUISITION An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. EVIDENCE SYNTHESIS Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. CONCLUSIONS PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,European Society of Residents in Urology (ESRU)
| | - Federica Balzarini
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy -
| | - Francesco Chierigo
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Young Academic Urologists (YAU) Urolithiasis & Endourology working party
| | - Michele Talso
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Esteban Emiliani
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Endourology and Urolithiasis Unit, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, University Hospital Southampton, Tremona Road, Southampton, UK
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU).,Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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5
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Mao T, Wei N, Yu J, Lu Y. Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis. J Int Med Res 2021; 49:300060520983136. [PMID: 33472474 PMCID: PMC7829524 DOI: 10.1177/0300060520983136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy
(LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones
larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National
Knowledge Infrastructure databases for studies that compared the surgical
outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved
studies, expressed as weighted mean difference or risk ratios with 95%
confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a
significantly higher stone-free rate, lower rates of blood loss,
complementary treatment, blood transfusion, and complications, and less
reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar
in terms of duration of hospital stay, conversion rate, changes in
glomerular filtration rate and creatinine level, and mean time of
postoperative analgesia. However, LPL was associated with a longer operation
time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large
renal stones, by increasing the stone-free rate and reducing blood loss,
complementary treatment, blood transfusion, and complications compared with
PCNL. LPL may thus be a useful modality for treating patients with large
renal stones.
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Affiliation(s)
- Tie Mao
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Na Wei
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Jing Yu
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Yinghui Lu
- Third Operating Room, The First Hospital of Jilin University, Changchun, China
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Ogunde B, Zaki-Metias KM, Kaur M, Dallo R, Al-Hameed M, Bhatti ZS. Spilled stones following pyelolithotomy: An unusual mimic of peritoneal carcinomatosis. Clin Imaging 2021; 77:69-75. [PMID: 33647633 DOI: 10.1016/j.clinimag.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 11/15/2022]
Abstract
While spillage of intraperitoneal gallstones has been reported frequently in the literature, spilled renal stones after urologic intervention is rare. The dropped renal stones may mimic peritoneal carcinomatosis (PC) on imaging, causing concern and potentially leading to unnecessary diagnostic workup. Additionally, these dropped stones may cause surrounding inflammation, potentially leading to the formation of adhesions or an intra-abdominal abscess. Calcifications along the peritoneal lining are generally interpreted as peritoneal carcinomatosis until proven otherwise. However, this case highlights the importance of a detailed history and comparison with prior imaging. We describe a rare case of intraperitoneal spilled renal stones after pyelolithotomy initially mistaken for PC, in addition to a review of diagnostic pitfalls and radiologic mimics of PC.
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Affiliation(s)
- Barakat Ogunde
- Department of Radiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac 48076, MI, United States
| | - Kaitlin M Zaki-Metias
- Department of Radiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac 48076, MI, United States.
| | - Mehrvaan Kaur
- Department of Radiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac 48076, MI, United States
| | - Rafat Dallo
- Ross University School of Medicine, Bridgetown, Barbados
| | - Mohammed Al-Hameed
- Department of Radiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac 48076, MI, United States
| | - Zeeshaan S Bhatti
- Department of Radiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac 48076, MI, United States; Huron Valley Radiology, 5301 McAuley Drive, Ypsilanti 48197, MI, United States
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7
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Rashid AO, Mahmood SN, Amin AK, Bapir R, Buchholz N. Multitract percutaneous nephrolithotomy in the management of staghorn stones. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00086-x] [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
Staghorn stones are difficult to manage with a risk of significant renal impairment and urosepsis. Percutaneous nephrolithotomy is the first-line treatment for staghorn stones. Often, multiple access tracts are needed to render the patient stone-free. PCNL has been combined with SWL, flexible URS (ECIRS), and mini-PCNL to access residual fragments without the need of additional tracts. However, in a country with limited access to technology and a restraint on resources, multitract PCNL still is the preferred option. The aim of this study was to assess the safety and efficacy of multitract PCNL in such an environment.
Methods
We analyzed data on sixty-five patients with staghorn calculus who underwent multitract PCNL for a staghorn calculus. Data included demographics, stone parameters, intraoperative parameters, complications and clinical outcomes. Hb-drop and creatinine changes were assessed pre- and post-OP. Complications were graded according to the modified Clavien-Dindo classification.
Results
In a total of 65 patients [47 males (72%)], 154 percutaneous access tracts were used in 66 renal units. The number of tracts varied between 2 and 4 in a single renal unit. The stone-free rate was 85%. 20% of patients developed grade I, 14% grade II, and 3% grade III b complications. There were no grade IV and V complications.
Conclusion
Multitract PCNL is safe and efficient, with a good stone-free rate and an acceptable complication rate. When auxiliary combination treatments are not available, multitract standard PCNL remains an option.
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8
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Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian J Urol 2020; 7:130-138. [PMID: 32257806 PMCID: PMC7096693 DOI: 10.1016/j.ajur.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
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Affiliation(s)
- Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chaoyue Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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9
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Singal R, Dhar S. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study. ACTA ACUST UNITED AC 2018; 91:85-91. [PMID: 29440956 PMCID: PMC5808274 DOI: 10.15386/cjmed-732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/30/2017] [Indexed: 11/23/2022]
Abstract
Background The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Aims and Objectives To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. Methods This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. Results The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Conclusion Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.
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Affiliation(s)
- Rikki Singal
- Surgery Department, MM University, Mullana, India
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10
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Swearingen R, Sood A, Madi R, Klaassen Z, Badani K, Elder JS, Wood K, Hemal A, Ghani KR. Zero-fragment Nephrolithotomy: A Multi-center Evaluation of Robotic Pyelolithotomy and Nephrolithotomy for Treating Renal Stones. Eur Urol 2017; 72:1014-1021. [DOI: 10.1016/j.eururo.2016.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/13/2016] [Indexed: 12/23/2022]
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Bai Y, Tang Y, Deng L, Wang X, Yang Y, Wang J, Han P. Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy. BMC Urol 2017; 17:75. [PMID: 28859655 PMCID: PMC5580319 DOI: 10.1186/s12894-017-0266-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/28/2017] [Indexed: 02/05/2023] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, laparoscopic pyelolithotomy (LPL) can be used as an alternative management procedure. The aim of present study was to compare LPL and PCNL in terms of efficacy and safety for the management of large renal pelvic stones. Methods A literature search was performed in Jan 2016 using electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) to identify relevant studies for the meta-analysis. Only comparative studies investigating LPL versus PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Results Five randomized and nine non-randomized studies were identified for analysis, involving a total of 901 patients. Compared with PCNL, LPL provided a significantly higher stone-free rate (OR 3.94, 95% CI 2.06–7.55, P < 0.001), lower blood transfusion rate (OR 0.28, 95% CI 0.13–0.61, P = 0.001), lower bleeding rate (OR 0.20, 95% CI 0.06–0.61, P = 0.005), fewer hemoglobin decrease(MD -0.80, 95% CI -0.97 to −0.63, P < 0.001), less postoperative fever (OR 0.38, 95% CI 0.21–0.68; P = 0.001), and lower auxiliary procedure rate (OR 0.24, 95% CI 0.12–0.46, P < 0.001) and re-treatment rate (OR 0.20, 95% CI 0.07–0.55, P = 0.002). However, LPL had a longer operative time and hospital stay. There were no significant differences in conversion to open surgery and prolonged urine leakage rates between LPL and PCNL. Conclusions Our present findings suggest that LPL is a safe and effective approach for management of patients with large renal stones. However, PCNL still suitable for most cases and LPL can be used as an alternative management procedure with good selection of cases. Electronic supplementary material The online version of this article (10.1186/s12894-017-0266-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Yin Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Lan Deng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Xiaoming Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang#37, Chengdu, Sichuan, 610041, China.
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12
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Liang T, Zhao C, Wu G, Tang B, Luo X, Lu S, Dong Y, Yang H. Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience. BMC Urol 2017; 17:15. [PMID: 28245870 PMCID: PMC5331685 DOI: 10.1186/s12894-017-0205-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The treatment of bilateral complex renal stones is a tough challenge for urologists. This study aimed to evaluate the efficiency and safety of bilateral ultrasonography-guided multi-tract percutaneous nephrolithotomy (PCNL) combined with EMS lithotripsy for the treatment of such cases. Methods Twenty-seven patients suffering from bilateral complex renal calculi underwent t bilateral multi-tract PCNL. The PCNL began with the establishment of percutaneous nephrostomy access, which was achieved under ultrasound guidance followed by stone fragment and removal by EMS lithotripsy. The same processes were then performed on the ipsilateral and contralateral renal units until the operation terminated. Sheaths left in situ to provide the tracts for the two-stage and the three-stage PCNL procedures. Peri- and postoperative clinical data were collected and analysed. Results Renal stones of both sides were completely cleared within three PCNL sessions in 24 cases. Among them, four, thirteen, and seven cases underwent single, second-stage and third-stage procedures, respectively. The total stone-free rate was 88.9%. Three patients failed to receive complete stone clearance. Mean operation time was 78.7 (26–124) min, the mean estimated blood loss was 97.3 (30–250) ml, and the mean length of hospital stay was 18 (10–31) days. No patient required blood transfusion and postoperative fever occurred in 6 cases. Within the follow-up period, stone recurrence occurred in 6 patients. Conclusions Ultrasonography-guided multi-tract PCNL using EMS is an efficient method for the treatment of complex renal calculi. According to our experience, it is safe to make multiple tracts on both sides simultaneously.
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Affiliation(s)
- Taisheng Liang
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Chenming Zhao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Wu
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Botao Tang
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Xiangdong Luo
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Shangguang Lu
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Yu Dong
- Department of Urology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Huan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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13
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Wang J, Yang Y, Chen M, Tao T, Liu C, Huang Y, Guan H, Han X, Xu B. Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter >2 cm): a meta-analysis. Acta Chir Belg 2016; 116:346-356. [PMID: 27684036 DOI: 10.1080/00015458.2016.1181312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2 cm. METHODS We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software. RESULTS Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I2 = 0, OR = 0.26 (95% CI 0.10-0.64), p = 0.003], lower drop in hemoglobin level [I2 = 0, difference in mean drop = -0.83 (95% CI -1.05 to -0.61), p < 0.00001] and lower postoperation fever [I2 = 0, OR = 0.36 (95% CI 0.14-0.89), p = 0.03], and PCNL is associated with a lower length of hospital stay [I2 = 74%, difference in mean of hospital stay = 0.72 (95% CI 0.04-1.40), p = 0.04]. CONCLUSION LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Jing Wang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Yiqiong Yang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Tao Tao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Yeqing Huang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Han Guan
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Xu Han
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Rui X, Hu H, Yu Y, Yu S, Zhang Z. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis. J Investig Med 2016; 64:1134-42. [DOI: 10.1136/jim-2015-000053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/23/2022]
Abstract
To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using the following search terms: renalpelvic stone, percutaneous nephrolithotomy, laparoscopic pyelolithotomy. Randomized controlled and prospective and retrospective two-armed studies were included. Sensitivity analysis and assessment of the quality of the included studies and publication bias were performed. Nine studies were included in the study with a patient population of 622. The studies were homogeneous with respect to the primary end point of stone-free rate, but were heterogeneous with respect to operation time, length of hospital stay, and blood loss. A higher percentage of patients who received LP remained stone-free following surgery compared with patients who were treated with PCNL (p=0.001). However, the mean operation time was longer for patients with LP than for those treated with PCNL (p=0.002). There was no difference between procedures with regard to length of hospital stay or blood loss (p≥0.071). Sensitivity and quality analysis indicated that the data are reliable and the included studies are of good quality. No publication bias was observed. The study suggests that both procedures are effective and safe for removing large renal stones. However, LP may be more efficacious than PCNL in treating large kidney stones.
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15
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Zhao C, Yang H, Tang K, Xia D, Xu H, Chen Z, Ye Z. Comparison of laparoscopic stone surgery and percutaneous nephrolithotomy in the management of large upper urinary stones: a meta-analysis. Urolithiasis 2016; 44:479-490. [PMID: 26936378 DOI: 10.1007/s00240-016-0862-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/08/2016] [Indexed: 12/30/2022]
Abstract
For the treatment of large upper urinary stones percutaneous nephrolithotomy (PCNL) is generally considered the first choice, and Laparoscopic Stone Surgery (LSS) is an alternative. We aim to compare the efficiency and safety of PCNL with LSS, as far as the management of large upper urinary stones is concerned. A systematic search from Pubmed, Web of Science, Wiley Online Library and Elsevier was performed up to August 1, 2015 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software. 15 eligible trials evaluating LSS vs. PCNL were identified including 6 prospective and 9 retrospective studies with 473 patients undergoing LSS and 523 patients undergoing PCNL. Although LSS led to longer operative time (p = 0.01) and higher open conversion rate (p = 0.02), patients might benefit from significantly fewer overall complications (p = 0.03), especially lower bleeding rate (p = 0.02), smaller drop in hemoglobin level (p < 0.001), less need of blood transfusion (p = 0.01). The stone free rate was also higher for LSS compared with PCNL (p < 0.001) with less secondary/complementary procedure (p = 0.006). There was no significant difference in other demographic parameters between the two groups. Our data suggests that LSS turns out to be a safe and feasible alternative to PCNL for large upper urinary stones with less bleeding and higher stone free rate. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric studies and randomized control trials should be undertaken to confirm our findings.
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Affiliation(s)
- Chenming Zhao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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蒲 小, 刘 久, 毕 学, 李 东, 黄 尚, 冯 彦, 林 楚. [Comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy for renal pelvic stones larger than 2.5 cm]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:251-255. [PMID: 28219872 PMCID: PMC6779669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To compare the safety, efficacy and complications of laparoscopic pyelolithotomy (LPL) and percutaneous nephrolithotomy (PCNL) for treatment of renal pelvic stones larger than 2.5 cm. METHODS From 2011 to 2016, 32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm. The baseline characteristics of the patients, stone size, mean operative time, estimated blood loss, postoperative hospital stay, stone-free rate, postoperative analgesia, blood transfusion, and the intraoperative, early postoperative and long-term complications were compared between the two groups. RESULTS The baseline characteristics and stone size were comparable between the two groups. The mean operative time of LPL and PCNL was 117∓23.12 and 118.16∓25.45 min, respectively (P>0.05). The two groups showed significant differences in the mean estimated blood loss (63∓11.25 vs 122∓27.78 mL, P<0.01) and blood transfusion rate (0 vs 6.2%, P<0.01) but not in postoperative hospital stay (4.5∓1.34 vs 4.8∓2.2 days, P>0.05), stone-free rate (93.1% vs 87.5%, P>0.05) or the postoperative analgesia time (1.7∓0.5 and 1.9∓0.6 days, P>0.05). The incidence of intraoperative complications were significant lower in LPL group than in PCNL group (6.2% vs 25.0%, P<0.01), but the incidences of early postoperative complications (25.0% vs 34.4%, P>0.05) and long-term postoperative complications (9.4% vs 12.5%, P>0.05) were similar between them. CONCLUSION PCNL is the standard treatment for pelvic stones larger than 2.5 cm, but for urologists experienced with laparoscopic technique, LPL provides a feasible and safe option for management of such cases.
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Affiliation(s)
- 小勇 蒲
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 久敏 刘
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 学成 毕
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 东 李
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 尚 黄
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 彦华 冯
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 楚琪 林
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
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17
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蒲 小, 刘 久, 毕 学, 李 东, 黄 尚, 冯 彦, 林 楚. [Comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy for renal pelvic stones larger than 2.5 cm]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:251-255. [PMID: 28219872 PMCID: PMC6779669 DOI: 10.3969/j.issn.1673-4254.2017.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the safety, efficacy and complications of laparoscopic pyelolithotomy (LPL) and percutaneous nephrolithotomy (PCNL) for treatment of renal pelvic stones larger than 2.5 cm. METHODS From 2011 to 2016, 32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm. The baseline characteristics of the patients, stone size, mean operative time, estimated blood loss, postoperative hospital stay, stone-free rate, postoperative analgesia, blood transfusion, and the intraoperative, early postoperative and long-term complications were compared between the two groups. RESULTS The baseline characteristics and stone size were comparable between the two groups. The mean operative time of LPL and PCNL was 117∓23.12 and 118.16∓25.45 min, respectively (P>0.05). The two groups showed significant differences in the mean estimated blood loss (63∓11.25 vs 122∓27.78 mL, P<0.01) and blood transfusion rate (0 vs 6.2%, P<0.01) but not in postoperative hospital stay (4.5∓1.34 vs 4.8∓2.2 days, P>0.05), stone-free rate (93.1% vs 87.5%, P>0.05) or the postoperative analgesia time (1.7∓0.5 and 1.9∓0.6 days, P>0.05). The incidence of intraoperative complications were significant lower in LPL group than in PCNL group (6.2% vs 25.0%, P<0.01), but the incidences of early postoperative complications (25.0% vs 34.4%, P>0.05) and long-term postoperative complications (9.4% vs 12.5%, P>0.05) were similar between them. CONCLUSION PCNL is the standard treatment for pelvic stones larger than 2.5 cm, but for urologists experienced with laparoscopic technique, LPL provides a feasible and safe option for management of such cases.
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Affiliation(s)
- 小勇 蒲
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 久敏 刘
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 学成 毕
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 东 李
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 尚 黄
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 彦华 冯
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
| | - 楚琪 林
- />广东省人民医院//广东省医学科学院泌尿外科,广东 广州510080Department of Urology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
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Rajiv Y, Kumar A, Poonam Y. Bilateral simultaneous robot-assisted pyelolithotomy for large (>6 cm) kidney stones: technique and review of literature. J Robot Surg 2015; 9:263-6. [DOI: 10.1007/s11701-015-0524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022]
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Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2-3 cm in diameter. BIOMED RESEARCH INTERNATIONAL 2015; 2015:914231. [PMID: 25821828 PMCID: PMC4363980 DOI: 10.1155/2015/914231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 12/18/2022]
Abstract
Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter.
Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.
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Bryniarski P, Miernik A, Schoenthaler M, Zyczkowski M, Taborowski P, Paradysz A. Kidney stones over 2 cm in diameter-between guidelines and individual approach. World J Clin Urol 2014; 3:81-86. [DOI: 10.5410/wjcu.v3.i2.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/25/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery (pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.
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