Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly

Abstract

The aim of this study is to compare the outcomes of flexible ureteroscopy (fURS) and minimally invasive percutaneous nephrolithotomy (mPNL) for the treatment of renal and/or proximal ureteral stones sized 1-2 cm in the elderly (≥60 years). Between January 2010 and March 2015, 184 consecutive mPNL and fURS were performed to treat intermediate renal and/or proximal ureteral stones in geriatric patients. The records were retrospectively reviewed and outcomes were compared. Although no significant difference was found in the complication rate between two groups, a statistical trend (p = 0.059) in favor of fURS was observed. In addition, multivariate analysis demonstrated that mPNL, preoperative positive urine culture and lower hemoglobin were independent risk factors for postoperative complication (p = 0.016, p = 0.021, p = 0.001, respectively). And fURS was significantly associated with less hemoglobin drop, red blood cell transfusion, analgesics requirement, postoperative hospital duration, and charges of laboratory tests, medical examinations and medications (p = 0.019, p = 0.037, p = 0.006, p = 0.000 and p = 0.007, p = 0.000, p = 0.000, p = 0.001, respectively), while higher costs of operations (p = 0.008). Receiver operating characteristic curve suggested a preoperative hemoglobin of 106.5 g/L as the threshold for predicting red blood cell transfusion after mPNL. The overall one-session stone-free rate of fURS at 1 month was lower (p = 0.006), while it was similar for solitary stone between two groups. Comorbidity and previous stone surgery did not affect postoperative complication and stone-free rate. This study shows that mPNL is more effective for multiple stones, but fURS is associated with potentially less complications and postoperative hospital stay. Furthermore, preoperative hemoglobin level and urine culture can be used to predict postoperative complication risk and they may be helpful in choosing treatment methods for the elderly.

Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones: A Systematic Review and Meta-Analysis

“…Table 1 provides a description of the 14 studies. Of the 14 included studies, 7 compared URS with LU [1,9,12] , 4 compared URS with PCNL [10,13,18,19], and 3 compared URS with LU or PCNL [6,8,11] . Among these 7 studies that compared URS with LU, 3 studies used the retrograde intrarenal surgery (RIRS) technique in the URS group comparing with LU [2,12,20] .…”

“…Among these 7 studies that compared URS with LU, 3 studies used the retrograde intrarenal surgery (RIRS) technique in the URS group comparing with LU [2,12,20] . In the URS vs. PCNL group, 2 studies used the mPCNL technique compared to RIRS [13,19] . The mean size of stones ranged from 12 to 23 mm.…”

“…The remaining 8 were non-RCTs. The methodological quality of included studies was relatively high for 6 of the nonrandomized studies [2,6,10,13,18,19] , and low for 1 [20] ( Table 1 ). For all of 7 RCTs, every RCT could achieve 3 or more items in the Cochrane Collaboration's tool for assessing the risk of bias respectively (online suppl.…”

“…The mean size of stones ranged from 12 to 23 mm. Ten trials reported the presence of complications [2,7,[10][11][12][13][18][19][20][21] . The complication rate ranged from 4.1 to 33.8%.…”

“…Seven trials were RCTs [1, 7-9, 11, 12, 21] of which 6 were retrospective control studies [2,6,11,[18][19][20] and 1 was a prospective control study [13] . The remaining 8 were non-RCTs.…”