Ya Xiao1, Qianwei Li2, Chibing Huang1, Pingxian Wang1, Jiaxi Zhang1, Weihua Fu3. 1. Department of Urology, XinQiao Hospital, Third Military Medical University, 37 XinQiao Street, Shapingba District, Chongqing, 400037, China. 2. Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China. 3. Department of Urology, XinQiao Hospital, Third Military Medical University, 37 XinQiao Street, Shapingba District, Chongqing, 400037, China. fuweihua80@sina.com.
Abstract
PURPOSE: To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. METHODS:From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. RESULTS: Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ±772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months. CONCLUSIONS:PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.
RCT Entities:
PURPOSE: To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. METHODS: From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. RESULTS: Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months. CONCLUSIONS: PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.
Authors: Ahmed R el-Nahas; Ibrahim Eraky; Ahmed A Shokeir; Ahmed M Shoma; Ahmed M el-Assmy; Nasr A el-Tabey; Shady Soliman; Ahmed M Elshal; Hamdy A el-Kappany; Mahmoud R el-Kenawy Journal: Urology Date: 2012-04-01 Impact factor: 2.649
Authors: Ahmed R El-Nahas; Ahmed A Shokeir; Ahmed M El-Assmy; Tarek Mohsen; Ahmed M Shoma; Ibrahim Eraky; Mahmoud R El-Kenawy; Hamdy A El-Kappany Journal: J Urol Date: 2007-02 Impact factor: 7.450
Authors: Ahmed R El-Nahas; Ibrahim Eraky; Ahmed A Shokeir; Ahmed M Shoma; Ahmed M El-Assmy; Nasr A El-Tabey; Hamdy A El-Kappany; Mahmoud R El-Kenawy Journal: BJU Int Date: 2010-12-16 Impact factor: 5.588
Authors: Jorge Gutierrez; Arthur Smith; Petrisor Geavlete; Hemendra Shah; Ali Riza Kural; Marco de Sio; José H Amón Sesmero; András Hoznek; Jean de la Rosette Journal: World J Urol Date: 2012-02-25 Impact factor: 4.226