Advertisement

World Journal of Urology

, Volume 36, Issue 8, pp 1309–1314 | Cite as

Comparative study of the treatment of 20–30 mm renal stones with miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy in obese patients

  • He-Qun Chen
  • Zhi-Yong Chen
  • Feng Zeng
  • Yang Li
  • Zhong-Qing Yang
  • Cheng He
  • Yao He
Original Article

Abstract

Purpose

To evaluate and compare flexible ureteroscopy (f-URS) and mini-percutaneous nephrolithotomy (mPNL) for 20–30 mm renal stones in obese patients regarding efficacy and safety.

Methods

Between May 2011 and June 2017, 254 obese patients who had 20–30 mm kidney stone were consecutively included in the study; 106 patients underwent mPNL and 148 underwent f-URS by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFR).

Results

F-URS group was similar to mPNL group in terms of the mean duration of surgery (92.8 ± 26.1 vs 87.4 ± 31.5 min, P = 0.137) and the final SFR (89.1 vs 92.5%, P = 0.381). The f-URS group had significantly shorter postoperative stay (1.0 ± 0.8 vs 4.3 ± 1.7 days, P < 0.001) and lower postoperative complications (11.5 vs 26.4%, P = 0.002). However, the f-URS group had a lower SFR after first session (67.2 vs 87.4%, P < 0.001) and needed more number of procedures (1.5 ± 0.4 vs 1.3 ± 0.4, P < 0.001) than the mPNL group.

Conclusions

MPNL has a higher efficacy (higher SFR after first session and lower number of procedures); however, f-URS offers advantages regarding safety (lower complication rate). Therefore, both options can be offered to obese patients with renal stones from 20 to 30 mm in size. Nevertheless, these results must be confirmed by further prospective randomized trials.

Keywords

MPNL F-URS Renal stones Obese Size 

Abbreviations

EAU

European Association of Urology

PNL

Percutaneous nephrolithotomy

f-URS

Flexible ureteroscopes

mPNL

Mini-percutaneous nephrolithotomy

URL

Ureteroscopic lithotripsy

CT

Computed tomography

SFR

Stone-free rates

KUB

Kidney ureter and bladder X-ray

UAS

Ureteral access sheath

SD

Standard deviation

BMI

Body Mass Index

ASA

American Society of Anesthesiologists

Notes

Acknowledgements

We thank Hugh McGonigle, from Liwen Bianji, Edanz Group China, for editing the English text of a draft of this manuscript.

Author contributions

HQC: Project development, data collection and management, data analysis, manuscript writing/editing. ZYC: Project development, data collection, manuscript editing. FZ: Data collection and management, manuscript editing. YL: Data collection, manuscript editing. ZQY: Data collection, manuscript editing. CH: Project development, data collection, manuscript editing. YH: Project development, data collection and management, data analysis, manuscript writing/editing.

Funding

Funding was provided by the National Natural Science Foundation of China 81770705 (to HQ Chen) and the National Natural Science Foundation of China 81700663 (to Yao He).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained preoperatively from all of our patients included in our study.

References

  1. 1.
    Wong YV, Cook P, Somani BK (2015) The association of metabolic syndrome and urolithiasis. Int J Endocrinol 2015:570674CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Krzysztoszek J, Wierzejska E, Zielinska A (2015) Obesity. An analysis of epidemiological and prognostic research. Arch Med Sci 11:24–33CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Türk C et al (2016) EAU Guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482CrossRefPubMedGoogle Scholar
  4. 4.
    El-Assmy AM et al (2007) Outcome of percutaneous nephrolithotomy: effect of Body Mass Index. Eur Urol 52:199–204CrossRefPubMedGoogle Scholar
  5. 5.
    Fuller A et al (2012) The CROES percutaneous nephrolithotomy global study: the influence of Body Mass Index on outcome. J Urol 188:138–144CrossRefPubMedGoogle Scholar
  6. 6.
    Streeper NM et al (2016) Percutaneous nephrolithotomy in patients with BMI > 50: single surgeon outcomes and feasibility. Urology 87:33–39CrossRefPubMedGoogle Scholar
  7. 7.
    Breda A et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater—is this the new frontier? J Urol 179:981–984CrossRefPubMedGoogle Scholar
  8. 8.
    Takazawa R, Kitayama S, Tsujii T (2012) Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater. Int J Urol 19:264–267CrossRefPubMedGoogle Scholar
  9. 9.
    Cohen J, Cohen S, Grasso M (2013) Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int 111:127–131CrossRefGoogle Scholar
  10. 10.
    Chen J et al (2014) Multiple tracts percutaneous nephrolithotomy assisted by LithoClast master in one session for staghorn calculi: report of 117 cases. Urolithiasis 42:165–169CrossRefPubMedGoogle Scholar
  11. 11.
    Chen HQ, Zeng F, Qi L, Li Y (2013) Percutaneous nephrolithotomy in patients with scoliosis: our institutional experience. Urolithiasis 41:59–64CrossRefPubMedGoogle Scholar
  12. 12.
    Chen H et al (2014) Percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in selected patients: killing two birds with one stone? Urology 84:1267–1271CrossRefPubMedGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Aboumarzouk OM et al (2012) Flexible ureteroscopy and laser lithotripsy for stones > 2 cm: a systematic review and meta-analysis. J Endourol 26:1257–1263CrossRefPubMedGoogle Scholar
  15. 15.
    Palmero JL et al (2014) Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm. Actas Urol Esp 38:257–262CrossRefPubMedGoogle Scholar
  16. 16.
    Aboumarzouk OM, Somani B, Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110:374–380CrossRefGoogle Scholar
  17. 17.
    Kamphuis GM et al (2015) Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 33:223–233CrossRefPubMedGoogle Scholar
  18. 18.
    Zhou X et al (2017) Effect of obesity on outcomes of percutaneous nephrolithotomy in renal stone management: a systematic review and meta-analysis. Urol Int 98:382–390CrossRefPubMedGoogle Scholar
  19. 19.
    Caskurlu T et al (2013) The impact of Body Mass Index on the outcomes of retrograde intrarenal stone surgery. Urology 81:517–521CrossRefPubMedGoogle Scholar
  20. 20.
    Doizi S et al (2015) Comparative study of the treatment of renal stones with flexible ureterorenoscopy in normal weight, obese, and morbidly obese patients. Urology 85:38–44CrossRefPubMedGoogle Scholar
  21. 21.
    Ishii H et al (2016) Outcomes of systematic review of ureteroscopy for stone disease in the obese and morbidly obese population. J Endourol 30:135–145CrossRefPubMedGoogle Scholar
  22. 22.
    Ozgor F et al (2016) Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for the management of 10–20 mm renal stones in obese patients. World J Urol 34:1169–1173CrossRefPubMedGoogle Scholar
  23. 23.
    Hyams ES, Shah O (2009) Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol 182:1012–1017CrossRefPubMedGoogle Scholar
  24. 24.
    Grasso M, Conlin M, Bagley D (1998) Retrograde ureteropyeloscopic treatment of 2 cm or greater upper urinary tract and minor staghorn calculi. J Urol 160:346–351CrossRefPubMedGoogle Scholar
  25. 25.
    Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal Stones larger than 2.5 cm. J Endourol 23:1395–1398CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • He-Qun Chen
    • 1
  • Zhi-Yong Chen
    • 1
  • Feng Zeng
    • 1
  • Yang Li
    • 1
  • Zhong-Qing Yang
    • 1
  • Cheng He
    • 1
  • Yao He
    • 1
  1. 1.Department of UrologyXiangya Hospital, Central South UniversityChangshaChina

Personalised recommendations