A case-control study of retrograde intrarenal surgery and second-stage percutaneous nephrolithotomy in the treatment of multiple residual stones after percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2019.03.013

Abstract

Abstract:

Objective

To compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and second-stage percutaneous nephrolithotomy (PCNL) in the treatment of multiple residual stones after PCNL.

Methods

A retrospective analysis of 78 patients with multiple residual stones after percutaneous nephrolithotomy in Donghua Affiliated Hospital of Sun Yat-sen University from August 2016 to August 2018, including 42 males and 36 females with an average age of (46±13) years. All the patients had 2-5 residual stones, single stone diameter≤2 cm. The procedure was performed at 5-7 days after one-stage PCNL when the drainage fluid of nephrostomy tube was clear. According to the treatment of the residual stone, the patients were divided into the ureteroscopy group (Group R) and the percutaneous nephrolithoscopic group (Group P). Group R included 43 cases and underwent flexible ureteroscopy lithotripsy. Group P included 35 cases and underwent multi-channel percutaneous nephrolithotomy on the basis of one-stage percutaneous nephrolithotomy.

Results

All the procedures were successfully performed without major complications. The differences of mean operative time and stone clearance rate in the P group and R group were not significant (P>0.05). The mean decreased value of hemoglobin concentration (0.95±0.86 vs 0.29±0.45 g/dl,P<0.05), the length of hospitalization (5.7±1.9 d vs 1.8±1.5 d,P<0.05) and the VAS value on the first day after operation (5.1 ± 1.1 vs 1.6 ± 0.7,P<0.05) in the P group was higher than that in the R group. The elevated value of serum creatinine on the first day after surgery was (0.22±0.04)mg/dl and (0.07±0.01)mg/dl in the P group and R group, respectively (P<0.05).

Conclusion

RIRS and second-stage PCNL in the treatment of multiple residual stones after PCNL are safe and effective. RIRS had advantages in terms of postoperative pain and recovery.

Key words: Residual stone, PCNL, RIRS, Case-control study

Dongling Du, Chunting Yang, Jiaqin Lin. A case-control study of retrograde intrarenal surgery and second-stage percutaneous nephrolithotomy in the treatment of multiple residual stones after percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(03): 194-197.

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References 15

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组别	例数	性别（例）		年龄（岁）	BMI（kg/m²）	结石位置(例)			结石数量（颗）	结石大小（cm）	术前血肌酐（mg/dl）	术前使用抗凝药物（例）	合并糖尿病（例）	合并高血压（例）
组别	例数	男	女	年龄（岁）	BMI（kg/m²）	上盏	中盏	下盏	结石数量（颗）	结石大小（cm）	术前血肌酐（mg/dl）	术前使用抗凝药物（例）	合并糖尿病（例）	合并高血压（例）
PCNL组	35	19	16	48.1±10.2	23.7±4.2	28	34	38	2.8±0.4	1.5±0.3	0.94±0.18	3	09	16
RIRS组	43	23	20	45.7±13.5	23.8±4.4	32	41	47	2.6±0.6	1.4±0.4	0.95±0.20	5	11	15
统计值	?	χ²=0.005		t=0.869	t=0.102	χ²=0.055			t=1.68	t=1.22	t=0.230	-	χ²=0.000	χ²=0.945
P值	?	0.955		0.388	0.919	0.973			0.095	0.225	0.819	0.724^a	0.987	0.331

组别	例数	性别（例）		年龄（岁）	BMI（kg/m²）	结石位置(例)			结石数量（颗）	结石大小（cm）	术前血肌酐（mg/dl）	术前使用抗凝药物（例）	合并糖尿病（例）	合并高血压（例）
组别	例数	男	女	年龄（岁）	BMI（kg/m²）	上盏	中盏	下盏	结石数量（颗）	结石大小（cm）	术前血肌酐（mg/dl）	术前使用抗凝药物（例）	合并糖尿病（例）	合并高血压（例）
PCNL组	35	19	16	48.1±10.2	23.7±4.2	28	34	38	2.8±0.4	1.5±0.3	0.94±0.18	3	09	16
RIRS组	43	23	20	45.7±13.5	23.8±4.4	32	41	47	2.6±0.6	1.4±0.4	0.95±0.20	5	11	15
统计值	?	χ²=0.005		t=0.869	t=0.102	χ²=0.055			t=1.68	t=1.22	t=0.230	-	χ²=0.000	χ²=0.945
P值	?	0.955		0.388	0.919	0.973			0.095	0.225	0.819	0.724^a	0.987	0.331

组别	例数	手术时间（min）	血红蛋白浓度下降（g/dl）	输血（例）	住院天数（d）	发热（例）	术后第1天血肌酐升高值（mg/dl）	术后1个月血肌酐（mg/dl）	术后第1天疼痛评分（分）	结石清除率[例(%)]
PCNL组	35	58±26	0.95±0.86	3	5.7±1.9	3	0.22±0.04	0.93±0.18	5.1±1.1	34(97.1)
RIRS组	43	68±21	0.29±0.45	0	1.8±1.5	1	0.07±0.01	0.94±0.15	1.6±0.7	37(86.0)
统计值	?	t=1.94	t=4.36	-	t=10.13	-	t=23.73	t=0.268	t=17.060	-
P值	?	0.056	<0.001	0.086^a	<0.001	0.321^a	<0.001	0.790	<0.001	0.122^a

组别	例数	手术时间（min）	血红蛋白浓度下降（g/dl）	输血（例）	住院天数（d）	发热（例）	术后第1天血肌酐升高值（mg/dl）	术后1个月血肌酐（mg/dl）	术后第1天疼痛评分（分）	结石清除率[例(%)]
PCNL组	35	58±26	0.95±0.86	3	5.7±1.9	3	0.22±0.04	0.93±0.18	5.1±1.1	34(97.1)
RIRS组	43	68±21	0.29±0.45	0	1.8±1.5	1	0.07±0.01	0.94±0.15	1.6±0.7	37(86.0)
统计值	?	t=1.94	t=4.36	-	t=10.13	-	t=23.73	t=0.268	t=17.060	-
P值	?	0.056	<0.001	0.086^a	<0.001	0.321^a	<0.001	0.790	<0.001	0.122^a

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