A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20–30 mm renal stones in obese patients

Abstract

Objective This study aimed to compare the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (F-URS) in the treatment of 20–30 mm renal stones in obese patients. Methods We conducted a retrospective analysis of outcomes of patients who underwent SMP and F-URS to treat 20–30 mm renal stones from August 2017 to September 2018. Patients with BMI >30 kg/m2 were enrolled into this study. Forty-eight patients underwent SMP, while 104 patients underwent F-URS by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, complications, stone-free rate (SFR) and overall costs were retrospectively assessed. Results No significant differences were found between the two groups in terms of age, gender, BMI, operation side, stone size, number, locations, stone compositions and CT value. The mean operation time was significantly shorter in the SMP group (p < 0.001), while the F-URS group had significantly shorter postoperative stays (p < 0.001) and lower complication rates (p < 0.001). Both groups had similar SFR at a 3-month follow-up (p = 0.190), while the SMP group achieved significant higher SFR 3 days after the operation (p < 0.001). The SMP group had a significantly lower overall cost and fewer stage-2 procedures than the F-URS group. Conclusion SMP and F-URS are equally effective in obese patients with 20–30 mm renal stones. However, F-URS offers the advantage of a lower complication rate, while SMP performed better in terms of operation time, tubeless rate, stage-2 procedures and overall costs.

Totally Ultrasound-Guided Minimally Invasive Percutaneous Nephrolithotomy in Children

“…In one study, two patients after mini-PCNL had Double J stent migration and underwent paediatric cystoscopy. [ 23 ] In the present study, two patients required Double J stent insertion. The final SFR was 96%, which was in the same line with a previously published report by Hosseini et al .…”

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis

“…We included two RCTs [7,12], one single-arm trial [5], and 11 cohort studies assessing SMP either alone or compared with different modalities [6,[8][9][10][11][13][14][15][16][17][18]. Table 1 and Table 2 exhibit the main summary and baseline characteristics of included studies.…”

“…Recently, several studies were performed to compare the safety and efficacy of SMP with other mini-PCNL techniques [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Guddeti et al performed a randomized clinical trial (RCT) to evaluate the efficacy of SMP versus standard PCNL in the management of renal calculi (<2 cm).…”

Outcomes of Ureterorenoscopy for Lower Pole Kidney Stones (≤3 cm) to the Omar Bongo Ondimba Army Instruction Hospital

“…The indications for FUR-L are becoming more and more precise, in first intention in the renal stone of the upper device and take a particular place in the stones of the lower chalice group [8] [9] [10]. Some authors make it a matter of course, compared to other procedures such as the mini PCNL, PCNL [9]. The international guidelines provide a high level of evidence for this indication [4] [5] [7].…”

“…Overall morbidity is estimated at 5% -10%, the risk of major complications (avulsion, perforation) is 1%, with a conversion rate of 0.2% [2] [13]. Other minimally invasive techniques are being learned here, but do not currently constitute an alternative to the ureteroscopy in the management of stones of the lower calyx [4] [7] [9]. In terms of cost, FUR-L is not within the reach of all patients, where the minimum wage is around 229 euros, the choice of the operating technique must take this into account.…”