Abstract
To create an easy risk stratification to recommend the optimal subset of patients with 2–3 cm kidney stones to receive retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (MPCNL). A retrospective patient cohort was reviewed and compared (RIRS, n = 147 and MPCNL, n = 129). Overall, RIRS group obtained a lower SFR (66% vs. 93.3%, p < 0.001) compared to MPCNL group. The RIRS group had more overall complication (12.2% vs. 8.5%) and more urosepsis (2.7% vs. 1.6%) than the MPCNL group, although there was no statistical significance. However, two patients in MPCNL group underwent embolization to treat perioperative bleeding. On multivariate analysis for RIRS group, lower calyx involved [OR 2.67], multiple calyces [OR 4.49], severe hydronephrosis [OR 2.38] were three significant predictors of SFR, which decreased from 88.8%, 70.3%, 52.1% to 25% corresponding to patients with 0, 1, 2, 3 risk predictors, respectively (p = 0.008), with a good predictive accuracy (AUC = 0.657; p = 0.002). When patients with no risk factor and patients undergoing RIRS had a similar high SFR and no possibility of bleeding, compared to matched patients undergoing MPCNL. Although generally RIRS showed a lower SFR for 2–3 cm stones compared to MPCNL, our easy risk stratification can recommend the optimal subset of patients with 2–3 cm kidney stones to receive RIRS or MPCNL. When these patients with no above-mentioned risk factors, RIRS can be first considered as an alternative to PCNL because it might be potentially less invasive and achieve a similar very high stone-free rate.
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References
Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906. https://doi.org/10.1016/j.eururo.2006.10.020(discussion 906)
Preminger GM, Assimos DG, Lingeman JE et al (2005) Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173:1991–2000
de la Rosette J, Assimos D, Desai M et al (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17. https://doi.org/10.1089/end.2010.0424
Breda A, Ogunyemi O, Leppert JT et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater—is this the new frontier? J Urol 179:981–984. https://doi.org/10.1016/j.juro.2007.10.083
Pan J, Chen Q, Xue W et al (2013) RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis 41:73–78. https://doi.org/10.1007/s00240-012-0533-8
Sabnis RB, Ganesamoni R, Doshi A et al (2013) Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 112:355–361. https://doi.org/10.1111/bju.12164
Gu X-J, Lu JL, Xu Y (2013) Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol 31:1605–1610. https://doi.org/10.1007/s00345-013-1026-2
Zengin K, Tanik S, Karakoyunlu N et al (2015) Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2–3 cm in diameter. Biomed Res Int 2015:914231. https://doi.org/10.1155/2015/914231
Atis G, Culpan M, Pelit ES et al (2017) Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating 20-40 mm renal stones. Urol J 14:2995–2999
Akman T, Binbay M, Ozgor F et al (2012) Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int 109:1384–1389. https://doi.org/10.1111/j.1464-410X.2011.10691.x
Sari S, Ozok HU, Cakici MC et al (2017) A comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for management of renal stones? 2 CM. Urol J 14:2949–2954
Zeng G, Zhu W, Li J et al (2015) The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol 33:1159–1164. https://doi.org/10.1007/s00345-014-1420-4
Kirac M, Bozkurt ÖF, Tunc L et al (2013) Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm. Urolithiasis 41:241–246. https://doi.org/10.1007/s00240-013-0552-0
Süer E, Gülpinar Ö, Özcan C et al (2015) Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm. Korean J Urol 56:138–142. https://doi.org/10.4111/kju.2015.56.2.138
Bozkurt OF, Resorlu B, Yildiz Y et al (2011) Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol 25:1131–1135. https://doi.org/10.1089/end.2010.0737
Sabnis RB, Jagtap J, Mishra S, Desai M (2012) Treating renal calculi 1-2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int 110:E346–E349. https://doi.org/10.1111/j.1464-410X.2012.11089.x
Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G (2011) Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World J Urol 29:755–759. https://doi.org/10.1007/s00345-011-0784-y
Resorlu B, Unsal A, Gulec H, Oztuna D (2012) A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the “resorlu-unsal stone score”. Urology 80:512–518. https://doi.org/10.1016/j.urology.2012.02.072
Jung J-W, Lee BK, Park YH et al (2014) Modified seoul national university renal stone complexity score for retrograde intrarenal surgery. Urolithiasis 42:335–340. https://doi.org/10.1007/s00240-014-0650-7
Jung H, Nørby B, Frimodt-Møller PC, Osther PJ (2008) Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 54:1404–1413. https://doi.org/10.1016/j.eururo.2008.03.092
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This study was supported in part by research Grants from National Natural Science Foundation of China (no. 81600542).
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ZZ: wrote the main manuscript text. HS and TZ: collected all the data. TD: prepared all tables and statistical work. GZ and YL: projects design and revised the manuscript.
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Zhao, Z., Sun, H., Zeng, T. et al. An easy risk stratification to recommend the optimal patients with 2–3 cm kidney stones to receive retrograde intrarenal surgery or mini-percutaneous nephrolithotomy. Urolithiasis 48, 167–173 (2020). https://doi.org/10.1007/s00240-019-01134-0
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DOI: https://doi.org/10.1007/s00240-019-01134-0