Comparision of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For The Treatment of Multicalyceal and Multiple Renal Stones
Vol. 15 No. 6 (2018),
AbstractPurpose: Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit.
Materials and Methods: Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups.
Result: There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively).
Conclusion: RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.
How to Cite
Türk C, Knoll T, Petrik A, et al. Guidelines on Urolithiasis. European Assocociation of Urology, 2015. http://uroweb.org/guideline/urolithiasis/
Matlaga BR, Lingeman JE. Surgical management of urinary lithiasis. Campbell’s Urology. 2012: 1358-1410.
Wilhelm K, Hein S, Adams F, et al. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stone 10-35 mm. World J Urol. 2015 ;33:2131-6.
Bryniarski P, Paradysz A, Zyczkowski M, et al. A Randomized Controlled Study to Analyze the Safety and Efﬁcacy of Percutaneous Nephrolithotripsy and Retrograde Intrarenal Surgery in the Management of Renal Stones More Than 2 cm in Diameter. J Endourol. 2012; 26(1): 52-57.
Zengin K, Tanik S, Karakoyunlu N, et al. Retrograde intrarenal surgery versus Percutaneous lithotripsy to treat renal stones 2-3 cm in diameter. Biomed Res Int. 2015;2015:914231.
Zheng C, Xiong B, Wang H, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones >2 cm: a meta-analysis. Urol Int. 2014;93(4):417-24.
De S, Autorino R, Kim FJ, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015 Jan;67(1):125-37.
Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol. 2011;25:1131-5.
Cecen K, Karadag MA, Demir A, et al. Flexible Ureterorenoscopy versus Extracorporeal Shock Wave Lithotripsy for the treatment of upper/middle calyx kidney stones of 10-20 mm: a retrospective analysis of 174 patients. SpringerPlus. 2014; 3: 557.
Resorlu B, Issi Y, Onem K, et al. Management of lower pole renal stones: the devil is in the details. Ann Transl Med. 2016 Mar;4(5):98.
Jung GH, Jung JH, Ahn TS, et al. Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study. Korean J Urol. 2015 Jul;56(7):525-32.
Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology. 1995;45:372-6.
Ozgor F, Kucuktopcu O, Ucpinar B, et al. Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden <300 mm2? Int Braz J Urol. 2016; 42:xx-xx
Tiselius HG,Anderson A. Stone burden in an avarage Swedish population of Stone formers requirng active Stone removal:How can the Stone size be estimated in the clinical routine? Eur Urol 2003;3:275-81.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. AnnSurg 2004; 240: 205-13.
Fernstrom I, Johansson B. Percutaneus pyelolithotomy: A new extraction technique. Scand J Urol Nephrol 1976;10:257.
Quaresima L, Conti A, Vici A, et al. Safety and efficacy of percutaneous nephrolithotomy in the Galdakao - Modified Supine Valdivia position: A prospective analysis. Arch Ital Urol Androl. 2016 Jul 4;88(2):93-96.
Pu C, Wang J, Tang Y, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis. 2015 Oct;43(5):455-466.
Huffman JL, Bagley DH, Lyon ES. Extending cystoscopic techniques into the ureter and renal pelvis. Experience with ureteroscopy and pyeloscopy. JAMA 1983;250:2002-5.
Fuchs GJ, Fuchs AM. Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment. Urologe A 1990;29:313-20.
Michel MS, Trojan L, and Rassweiler JJ. Complications in percutaneous nephrolithotomy. European Urology; 51(4): 899–906.
Karakan T, Kilinc MF, Doluoglu OG, Yildiz Y, Yuceturk CN, Bagcioglu M, Karagöz MA, Bas O, Resorlu B. The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study. Urolithiasis. 2016 May 12. [Epub ahead of print]
Unsal A, Resorlu B, Kara C, Bayindir M. The role of percutaneous nephrolithotomy in the management of medium-sized (1-2 cm) lower-pole renal calculi. Acta Chir Belg. 2011 Sep-Oct;111(5):308-11.
Demirbas A, Resorlu B, Sunay MM, et al. Which should be preferred for moderate-size kidney stones? Ultramini percutaneous nephrolithotomy or retrograde intrarenal surgery? J Endourol. 2016 Dec;30(12):1285-1289.
Zhang W, Zhou T, Wu T, et al. Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review. J Endourol. 2015 Jul;29(7):745-59.
Cass AS. Comparison of first generation (Dornier HM3) and second generation (Medstone STS) lithotriptors: treatment results with 13,864 renal and ureteral calculi. J Urol. 1995;153:588-92.
McAdams S, Kim N, Ravish IR, Monga M, Ugarte R, Nerli R, et al. Stone size is only independent predictor of shock wave lithotripsy success in children: a community experience. J Urol. 2010;184:659-64.
Gorbachinsky I, Wood K, Colaco M, et al. Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of PercutaneousAccess Tracts Matter? J Urol. 2016 Jul;196(1):131-136.
Choi SW, Bae WJ, Ha US, et al. Prognostic Impact of Stone-Scoring Systems After Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience Over 10 Years. J Endourol. 2016 Sep;30(9):975-981.
Armitage JN, Irving SO, Burgess NA. British Association of Urological Surgeons Section of Endourology. Percutaneous nephrolithotomy in the United Kingdom: results of a prospective data registry. Eur Urol 2012;61:1188–93.
Ganpule AP, Mishra S, Desai MR. Multiperc versus single perc with flexible instrumentation for staghorn calculi. J Endourol. 2009 Oct;23:1675-8.
- Abstract Viewed: 821 times
- PDF Downloaded: 279 times
- Video Downloaded: 70 times