Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of lower pole minor staghorn calculi

doi:10.3877/cma.j.issn.1674-3253.2022.06.010

Abstract

Abstract:

Objective

To compare the safety and efficacy of percutaneous nephrolithotomy(PCNL) and flexible ureteroscopy(FURS) in treatment of lower pole minor staghorn calculi.

Methods

From April 2017 to April 2019, 43 patients having lower pole minor staghorn calculi were treated with PCNL or FURS in our hospital. The patients were all retrospectively investigated and classified as PCNL group or FURS group. Of them, 20 patients received PCNL and 23 underwent FURS, respectively. The two groups were compared and analyzed statistically in terms of operation time, stone-free rate, surgical-related complications rate and postoperative hospital stay.

Results

Successful surgery had been done in all the patients. Operation time and postoperative hospital stay of the PCNL group were significantly longer than that of the FURS group (P<0.05). In PCNL group, initial stone-free rate(SFR) in 4 days after surgeries achieved 85.0%, which was significantly higher than that of 52.2% in FURS group (P<0.05). However, there was no significant difference between the two groups in terms of overall SFR in 4 weeks and 6 months after surgeries, respectively (P>0.05). Nevertheless, the need for further intervention(staged FURS surgery or ESWL) in the FURS group was significantly more than that in the PCNL group (P<0.05). Complication rate between the two groups was similar in terms of postoperative fever, bleeding and steinstrasse (P>0.05), but the PCNL group suffered more loss of hemoglobin and postoperative pain (P<0.05).

Conclusions

Both PCNL and FURS are safe and feasible for patients with minor renal staghorn calculi in the lower pole. Compared to PCNL, FURS deserves its priority to deal with lower pole minor staghorn calculi for its less invasive and faster postoperative recovery.

Key words: Percutaneous nephrolithotomy(PCNL), Flexible ureteroscopy(FURS), Lower pole stone, Staghorn calculi

Shengsheng Song, Zhiwen Gu, Rizhao Tan, Lilin Tan, Chenyao Jia, Bin Zheng. Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of lower pole minor staghorn calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(06): 534-538.

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References 19

[1]	Lahme S, Bichler KH, Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones[J]. Eur Urol, 2001, 40(6): 619-624.
[2]	Vargas AD, Bragin SD, Mendez R. Staghorn calculus: its clinical presentation, complications and management[J]. J Urol, 1982, 127(5): 860-862.
[3]	Aljuhayman A , Abunohaiah I , Addar A, et al. Assessment of lower calyceal single-access percutaneous nephrolithotomy for staghorn stones: A single-surgeon and a single-center experience at KAMC, Riyadh[J]. Urol Ann, 2019, 11(1): 62-65.
[4]	Yu W, Yao J, Zhang D, et al. Clinical factors of stone free rates after percutaneous nephrolithotomy for staghorn calculi[J]. Int J Clin Exp Med, 2016, 9(4): 7289-7296.
[5]	Qi S, Li L, Liu R, et al. Impact of stone branch number on outcomes of percutaneous nephrolithotomy for treatment of staghorn calculi[J]. J Endourol, 2014, 28(2): 152-157.
[6]	Singh BP, Dhakad U. Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone[J]. Urology, 2012, 79(6): 1236-1241.
[7]	齐士勇, 张志宏, 张昌文, 等. 鹿角形肾结石分支数对经皮肾镜取石术的影响[J]. 中华外科杂志, 2013, 51(12): 1085-1088.
[8]	章尹岗, 刘文. 经皮肾镜取石术并发出血的危险因素分析[J]. 中国内镜杂志, 2018, 24(6): 83-87.
[9]	Sanguedolce F, Liatsikos E, Verze P, et al. Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large european survey conducted by the eau young academic urologists-working party on endourology and urolithiasis[J]. Urolithiasis, 2014, 42(4): 329-334.
[10]	Türk C, Petřík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis[J]. Eur Urol, 2016, 69(3): 468-474.
[11]	Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi[J]. BJU international, 2013, 111(3b), e127-e131.
[12]	李龚龙, 乔庆东, 王磊, 等. 输尿管软镜钬激光碎石术治疗鹿角形肾结石疗效分析[J]. 河南外科学杂志, 2016, 22(6): 10-12.
[13]	Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor staghorn calculi[J]. Urol J, 1998, 160(2): 346-351.
[14]	Ryoji T, Sachi K, Toshihiko T. Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater[J]. Int J Urol, 2012, 19(3): 264-267.
[15]	Oner S, Okumus MM, Demirbas M, et al. Factors influencing complications of percutaneous nephrolithotomy: a single-center study[J]. Urol J, 2015, 12(5): 2317-2323.
[16]	Ullah S, Ali S, Karimi S, et al. Frequency of blood transfusion in percutaneous nephrolithotomy[J]. Cureus, 2020, 12(10): e11086-e11094.
[17]	Keoghane SR, Cetti RJ, Rogers AE, et al. Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL)[J]. BJU International, 2013, 111(4): 628-632.
[18]	Meng X, Bao J, Mi Q, et al. The analysis of risk factors for hemorrhage associated with minimally invasive percutaneous nephrolithotomy[J]. BioMed Res Int, 2019, 2019(5): 1-6
[19]	刘杰, 白大应, 石磊, 等. 输尿管软镜与微通道经皮肾镜治疗2~3 cm肾结石的对照研究[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 375-379.

组别	例数	年龄[岁，(±s)]	性别(例)		结石侧别(例)		结石最大径[mm，(±s)]	结石分支(例)		肾积水(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	结石最大径[mm，(±s)]	两个分支	三个分支	有	无
PCNL组	20	61±11	8	12	9	11	19.2±3.6	15	5	4	16
FURS组	23	59±8	14	9	13	10	18.6±4.3	16	7	6	17
统计值		t=0.529	χ²=1.865		χ²=0.568		t=0.410	χ²=0.157		χ²=0.012
P值		0.599	0.172		0.451		0.684	0.692		0.913

组别	例数	年龄[岁，(±s)]	性别(例)		结石侧别(例)		结石最大径[mm，(±s)]	结石分支(例)		肾积水(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	结石最大径[mm，(±s)]	两个分支	三个分支	有	无
PCNL组	20	61±11	8	12	9	11	19.2±3.6	15	5	4	16
FURS组	23	59±8	14	9	13	10	18.6±4.3	16	7	6	17
统计值		t=0.529	χ²=1.865		χ²=0.568		t=0.410	χ²=0.157		χ²=0.012
P值		0.599	0.172		0.451		0.684	0.692		0.913

组别	例数	手术时间[min，(±s)]	术后住院天数[d，中位数(范围)]	术后1~4 d结石清除率[例(%)]	术后4周结石清除率[例(%)]	术后半年结石清除率[例(%)]	二次干预率[例(%)]
PCNL组	20	106±12	6.5(5.0~14.0)	17(85.0)	17(85.0)	18(90.0)	1(5.0)
FURS组	23	73±11	2.0(1.0~6.0)	12(52.2)	17(73.9)	20(82.6)	9(39.1)
统计值		t=9.358	Z=-5.431	χ²=3.861	χ²=0.266	χ²=0.000	χ²=5.201
P值		<0.001	<0.001	0.049	0.606	1.000	0.023

组别	例数	手术时间[min，(±s)]	术后住院天数[d，中位数(范围)]	术后1~4 d结石清除率[例(%)]	术后4周结石清除率[例(%)]	术后半年结石清除率[例(%)]	二次干预率[例(%)]
PCNL组	20	106±12	6.5(5.0~14.0)	17(85.0)	17(85.0)	18(90.0)	1(5.0)
FURS组	23	73±11	2.0(1.0~6.0)	12(52.2)	17(73.9)	20(82.6)	9(39.1)
统计值		t=9.358	Z=-5.431	χ²=3.861	χ²=0.266	χ²=0.000	χ²=5.201
P值		<0.001	<0.001	0.049	0.606	1.000	0.023

组别	例数	术后血红蛋白下降值[g/L，中位数(范围)]	止痛药使用率[例(%)]	发热(>38.5℃)[例(%)]	出血[例(%)]	石街形成[例(%)]
PCNL组	20	26.5(12.0~43.0)	9(45.0)	1(5.0)	2(10.0)	0(0)
FURS组	23	17.0(-16.0~27.0)	2(8.7)	2(8.7)	0(0)	2(8.7)
统计值		Z=-3.361	χ²=5.622	χ²=0.00	-	-
P值		0.001	0.018	1.0000	0.210	0.491

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