Jeong Woo Lee1, Juhyun Park2, Seung Bae Lee2, Hwancheol Son2, Sung Yong Cho3, Hyeon Jeong4. 1. Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea. 2. Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. Electronic address: kmoretry@daum.net. 4. Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. Electronic address: drjh@brm.co.kr.
Abstract
OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the management of renal stones >10 mm in a single session. METHODS:Seventy patients presenting with renal stones >10 mm were randomized to a mini-PCNL or an RIRS group in a ratio of 1:1. Randomization was performed by a biostatistician and opened to the surgeon at the time of the patient's admission on the day before surgery. Patient and stone characteristics, perioperative outcomes, and complications were compared between the 2 groups. The primary end point of "stone-free" which was defined as no residual stone or stones <2 mm on computed tomography within 3 months postoperatively. RESULTS:Thirty-five patients (mini-PCNL) and 33 (RIRS) were included in the final analysis. Mini-PCNL and RIRS had a stone-free rate of 85.7% and 97.0%, respectively (P = .199). Operation time (P = .148), hemoglobin decline (P = .323), and hospital stay (P = .728) were similar between the 2 groups. Pain visual analog score at 1 hour postoperatively (P = .029) and analgesic requirement (P = .050) were higher in the RIRS group. Two patients in the mini-PCNL group and 1 in the RIRS group had minor pelvic or ureter perforation. One patient in each of the 2 groups had hypertension and urinary tract infection. CONCLUSION:Mini-PCNL and RIRS are safe and feasible surgical options to manage renal stones >10 mm. RIRS produced a slightly higher stone-free rate, but more immediate postoperative pain and higher analgesic requirement compared with mini-PCNL.
RCT Entities:
OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the management of renal stones >10 mm in a single session. METHODS: Seventy patients presenting with renal stones >10 mm were randomized to a mini-PCNL or an RIRS group in a ratio of 1:1. Randomization was performed by a biostatistician and opened to the surgeon at the time of the patient's admission on the day before surgery. Patient and stone characteristics, perioperative outcomes, and complications were compared between the 2 groups. The primary end point of "stone-free" which was defined as no residual stone or stones <2 mm on computed tomography within 3 months postoperatively. RESULTS: Thirty-five patients (mini-PCNL) and 33 (RIRS) were included in the final analysis. Mini-PCNL and RIRS had a stone-free rate of 85.7% and 97.0%, respectively (P = .199). Operation time (P = .148), hemoglobin decline (P = .323), and hospital stay (P = .728) were similar between the 2 groups. Pain visual analog score at 1 hour postoperatively (P = .029) and analgesic requirement (P = .050) were higher in the RIRS group. Two patients in the mini-PCNL group and 1 in the RIRS group had minor pelvic or ureter perforation. One patient in each of the 2 groups had hypertension and urinary tract infection. CONCLUSION: Mini-PCNL and RIRS are safe and feasible surgical options to manage renal stones >10 mm. RIRS produced a slightly higher stone-free rate, but more immediate postoperative pain and higher analgesic requirement compared with mini-PCNL.
Authors: Joo Yong Lee; Seong Uk Jeh; Man Deuk Kim; Dong Hyuk Kang; Jong Kyou Kwon; Won Sik Ham; Young Deuk Choi; Kang Su Cho Journal: BMC Urol Date: 2017-06-27 Impact factor: 2.264