Yuanqi Cheng1, Ruoshan Xu1. 1. Department of Urology, Hangzhou Fuyang Hospital of Traditional Chinese Medicine Hangzhou City, Zhejiang Province, China.
Abstract
OBJECTIVE: To compare the effectiveness and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of isolated kidney stones. METHODS: A retrospective analysis was performed on 99 patients with isolated kidney stones treated in our hospital. Patients were divided into a flexible cystoscope group (FCG, n=48, receiving RIRS) and a nephoscopy group (NG, n=51, receiving PCNL) according to the operation methods. The two groups were compared in terms of the operative time, intraoperative bleeding, length of hospitalization, time to bowel function recovery, cost of hospitalization, one-session stone clearance, postoperative incidence of massive hemorrhage, postoperative 1-year recurrence rate, and levels of hemoglobin, urinary kidney injury molecule-1 (Kim-1), cysteine protease inhibitor C (Cys-C), interleukin (IL)-6, IL-10, cortisol (Cor), white blood cells (WBC) and C-reactive protein (CRP). RESULTS: The two groups exhibited significant differences in operation time, intraoperative bleeding, hospital stay, time to bowel function recovery and medical costs (P < 0.05). The NG had a single session stone clearance rate of 88.24% and a total stone clearance rate of 98.04%, which were higher than 70.83% and 83.33%, respectively, in the FCG (P < 0.05). The incidence of postoperative hemorrhage in the NG was 15.69%, which was higher than 2.08% in the FCG (P < 0.05). The postoperative 1-year recurrence rate was 9.80% in the NG and 6.25% in the FCG (P > 0.05). The hemoglobin level of the NG was lower than that of the FCG at 1 day after surgery, and the decrease in the NG were greater than that in the FCG (P < 0.05). The levels of Kim-1 in the NG were higher than those in the FCG at 48 h postoperatively. The levels of Cys-C in the NG were lower than those in the FCG at 12 h, 24 h, 48 h and 72 h postoperatively (P < 0.05). The NG showed higher levels of IL-6, Cor, WBC and CRP, and lower level of IL-10 as compared with the FCG at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively (P < 0.05). The levels of IL-10 in both groups at different time points after surgery were higher than those before surgery, and the levels of IL-6, Cor, WBC and CRP in both groups at 6 h, 12 h, 24 h, and 48 h after surgery were higher than those before surgery (P < 0.05), whereas there was no significant difference in IL-6, Cor, WBC and CRP at 72 h after surgery as compared with those before surgery (P > 0.05). CONCLUSION: Both RIRS and PCNL were effective in the treatment of isolated kidney stones, so the surgical methods should be specifically selected in clinical practice according to individual patient conditions. AJTR
OBJECTIVE: To compare the effectiveness and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of isolated kidney stones. METHODS: A retrospective analysis was performed on 99 patients with isolated kidney stones treated in our hospital. Patients were divided into a flexible cystoscope group (FCG, n=48, receiving RIRS) and a nephoscopy group (NG, n=51, receiving PCNL) according to the operation methods. The two groups were compared in terms of the operative time, intraoperative bleeding, length of hospitalization, time to bowel function recovery, cost of hospitalization, one-session stone clearance, postoperative incidence of massive hemorrhage, postoperative 1-year recurrence rate, and levels of hemoglobin, urinary kidney injury molecule-1 (Kim-1), cysteine protease inhibitor C (Cys-C), interleukin (IL)-6, IL-10, cortisol (Cor), white blood cells (WBC) and C-reactive protein (CRP). RESULTS: The two groups exhibited significant differences in operation time, intraoperative bleeding, hospital stay, time to bowel function recovery and medical costs (P < 0.05). The NG had a single session stone clearance rate of 88.24% and a total stone clearance rate of 98.04%, which were higher than 70.83% and 83.33%, respectively, in the FCG (P < 0.05). The incidence of postoperative hemorrhage in the NG was 15.69%, which was higher than 2.08% in the FCG (P < 0.05). The postoperative 1-year recurrence rate was 9.80% in the NG and 6.25% in the FCG (P > 0.05). The hemoglobin level of the NG was lower than that of the FCG at 1 day after surgery, and the decrease in the NG were greater than that in the FCG (P < 0.05). The levels of Kim-1 in the NG were higher than those in the FCG at 48 h postoperatively. The levels of Cys-C in the NG were lower than those in the FCG at 12 h, 24 h, 48 h and 72 h postoperatively (P < 0.05). The NG showed higher levels of IL-6, Cor, WBC and CRP, and lower level of IL-10 as compared with the FCG at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively (P < 0.05). The levels of IL-10 in both groups at different time points after surgery were higher than those before surgery, and the levels of IL-6, Cor, WBC and CRP in both groups at 6 h, 12 h, 24 h, and 48 h after surgery were higher than those before surgery (P < 0.05), whereas there was no significant difference in IL-6, Cor, WBC and CRP at 72 h after surgery as compared with those before surgery (P > 0.05). CONCLUSION: Both RIRS and PCNL were effective in the treatment of isolated kidney stones, so the surgical methods should be specifically selected in clinical practice according to individual patient conditions. AJTR
Authors: Á A Fernández Alcalde; M Ruiz Hernández; V Gómez Dos Santos; C Sánchez Guerrero; D E Diaz Pérez; F Arias Fúnez; I Laso García; G Duque Ruiz; F J Burgos Revilla Journal: Actas Urol Esp (Engl Ed) Date: 2018-12-07