Clinical and psychological outcomes of patients undergoing Retrograde Intrarenal Surgery and Miniaturised Percutaneous Nephrolithotomy for kidney stones. A preliminary study

Abstract

Purpose: To assess disease-specific and health-related QoL, anxiety and depression as well as satisfaction regarding retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) intervention for kidney stones up to 2.5 cm. Secondarily, pain as well as perioperative and postoperative patient outcomes were evaluated. Methods: 60 consecutive patients with kidney stones of dimensions not exceeding 2.5 cm were enrolled in the study of which 30 underwent RIRS and 30 mPCNL. Perioperative characteristics (age, gender, body mass index (BMI), stone side and size, previous interventions for kidney stones and duration of hospitalization) and surgical outcomes (hemoglobin drop, stone-free rate, visual analogue scale (VAS), stenting time, size of ureteral access sheath (UAS) deployment, and postoperative complications) of patients were collected. Quality of life and psychological outcomes were evaluated using validated questionnaires. Results: No significant differences were found between the two groups in terms of age, gender, BMI, stone side and size (p > 0.05). Significant differences between the mPCNL and the RIRS groups were found regarding stenting time (p = 0.032) and duration of hospital stay (p < 0.001). The stone-free rates of mPCNL vs RIRS were not significantly different between the two groups (73.3% vs 66.7%, p > 0.05). Peri- and postoperative complications were not statistically different between the two groups (p > 0.05). RIRS group reported higher anxiety and depression scores compared with the mPCNL group (3 [range 0-15] vs 15 [range 6-24], p < 0.01). We found significant differences between the two groups in social (p < 0.05) and vitality (p < 0.01) scores. VAS pain score was significantly lower in the mPCNL group than in the RIRS one (p < 0.05). Conclusions: These results open new scenarios in the treatment of kidney stones up to 2.5 cm when RIRS and mPCNL have interchangeable indications. Since in our experience complications and success rate are similar, the surgical choice of switching from RIRS to mPCNL in real-time and viceversa may be proposed to the patient in the preoperative counseling.

Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases

“…In our study SFR was 86% with a mean operative time of 72 minutes. These results are comparable to the main previous literature (10)(11)(12). Even if RIRS is generally considered a safe procedure, a wide spectrum of intra and mostly post-operative severe events must be considered.…”

“…Various authors have tried to understand what is the cause of subcapsular renal hematoma: increase intrarenal pressure leading to rupture of the fornix and separation of the capsule from the parenchyma, urinary infection and infiltration of leukocytes into the parenchyma which can be damaged by irrigation, laser and guide wires (19)(20)(21)(22). The sudden expansion and rupture of renal parenchyma is probably the most likely explanation of our cases.…”

Mini percutaneous nephrolithotomy versus retrograde flexible ureterorenoscopy in the treatment of renal calculi in anomalous kidneys

“…This group reported significantly greater hemoglobin drop 0.47 g/dl than in flexible URS group and required blood transfusion in one patient (3.3%). Blood loss was comparable to what reported by similar studies, due to the presence of abnormal vasculature (6,13,14). However, none of our patients in the mini-perc group required angio-embolization, that was reported in some studies using standard PNL (15).…”

Measuring quality of life among patients with urinary stone disease; A qualitative study

“…Furthermore, the severity and length of these symptoms were more significant in these groups than in patients with recurring and/or renal stones because patients with the first stone formation and/or ureteric stones rated the symptoms as severe, frequent, and lasting a long time. Although a small percentage of people reported this topic, psychological problems can significantly impact the human outcome because they affect all elements of life (13,14). A well-structured assessment and intervention are required for those patients to enhance and follow the patients' psychological health as indicated by many previous studies (1,7,14).…”

“…Although a small percentage of people reported this topic, psychological problems can significantly impact the human outcome because they affect all elements of life (13,14). A well-structured assessment and intervention are required for those patients to enhance and follow the patients' psychological health as indicated by many previous studies (1,7,14).…”