Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy’s Stone Score Grade IV Kidney Stone

Abstract

Background and Objective: The aim of this study was to compare the efficacy and reliability of holmium (Ho:YAG) laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in percutaneous nephrolithotomy (PCNL) in the treatment of patients with Grade IV kidney stones based on Guy’s Stone Score. Study Design/Materials and Methods: This retrospective study included 103 patients with Grade IV kidney stones out of 440 patients who underwent PCNL through HLL and PL in Second Affiliated Hospital of Shantou University Medical College, China, from January 2016 to December 2018. We analyzed preoperative, intraoperative, and postoperative variables of the patients to evaluate the efficacy and reliability of PCNL procedures. Results: Patients were categorized as Grade I, II, III, and IV, and the patients of each grade were 85 (19.32%), 39 (8.86%), 213 (48.41%), and 103 (23.41%), respectively. In Grade IV, the total operative time (min) for the PL and HLL groups was 137.7 ± 47.79 and 134.27 ± 53.38, respectively (p = 0.744). The variation in laboratory examination values including ΔHGB (g/L), ΔHCT, ΔPCT, and ΔCr (μmol/L) for PL and HLL groups was 19 ± 11.23/12 ± 15.42 (p = 0.012), 0.057 ± 0.034/0.038 ± 0.045 (0.009), 0.027 ± 0.034/0.026 ± 0.034 (0.702), and 3.07 ± 17.4/20.54 ± 65.93 (0.692), respectively. The postoperative hospitalization day was 8.94 ± 4.2 and 7.73 ± 2.75 (p = 0.015), respectively. As for the stone-free rate (SFR), the SFRs for PL and HLL were 48.15% (n = 39/81) and 59.09% (n = 13/22) (p = 0.363), respectively. Conclusions: HLL showed a comparable advantage of not only decreased postoperative hemoglobin and hematocrit but also fewer postoperative hospitalization days. Based on the results of our retrospective study, for those Grade IV kidney stone patients who have a risk of bleeding before PCNL operation, HLL can be a considerable treatment option. Besides, in consideration of reducing human care cost, HLL which showed fewer hospitalization days, would be more welcome by patients.

Comparison of standard-percutaneous nephrolithotomy combined ultrasonic lithotripsy system and mini-percutaneous nephrolithotomy combined high-power holmium laser for staghorn calculus: A retrospective comparative study

“…Most of previous study as 4 mm [18,25].The second SFR of s-PCNL+ULSand m-PCNL+hHL were comparable to previous study(second SFR were 82.1% and 84.2%). In the present study the number of tracts(1.35(s-PCNL+ULS), 1.20(m-PCNL+hHL)) were lesser then previous study [18,25], but we have comparable SFR because of exible ureteroscope-assisted PCNL was used in m-PCNL+hHL(47 patients) and s-PCNL+ULS(10 patients) in rist procedure. It may be di cult to see all kidney stones during single-tract percutaneous nephrolithotomy for staghorn kidney stones, there is a 20-50% probability that another percutaneous nephrolithotomy is needed, However, increasing the percutaneous renal channel will increase the risk of renal parenchymal injury.…”

“…The rist SFR of complete staghorn for m-PCNL+hHL was lower then previous study by Hong YX et al [25] (59.09% Guy's Stone Score Grade IV) maybe attribute to the de nition of residual fragments, in the present study SFR was de ned as<3 mm. Most of previous study as 4 mm [18,25].The second SFR of s-PCNL+ULSand m-PCNL+hHL were comparable to previous study(second SFR were 82.1% and 84.2%).…”

“…The rist SFR of complete staghorn for m-PCNL+hHL was lower then previous study by Hong YX et al [25] (59.09% Guy's Stone Score Grade IV) maybe attribute to the de nition of residual fragments, in the present study SFR was de ned as<3 mm. Most of previous study as 4 mm [18,25].The second SFR of s-PCNL+ULSand m-PCNL+hHL were comparable to previous study(second SFR were 82.1% and 84.2%). In the present study the number of tracts(1.35(s-PCNL+ULS), 1.20(m-PCNL+hHL)) were lesser then previous study [18,25], but we have comparable SFR because of exible ureteroscope-assisted PCNL was used in m-PCNL+hHL(47 patients) and s-PCNL+ULS(10 patients) in rist procedure.…”

“…But the blood transfusion rates between the groups were comparable, because the decrease of hemoglobin is no more than that of blood transfusion. which was proved by previous studies [18,25,31]. Severe blood loss require renal arteriography and selective embolization or nephrectomy.…”

Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study

“…29 Some studies have shown that multiple tract and ultrasonographic combined with fluoroscopic guidance can increase operation time, and the pneumatic lithotripsy and holmium laser lithotripsy had similar operation time. [30][31][32] In this study, we analyzed the correlation between puncture mode, tract number, lithotripsy method, and operation time and found that there was no correlation (Supplementary Table S1). Therefore, we have reason to believe that in this study, the higher multiple-tract rate, the higher combined guidance rate, and the higher holmium laser lithotripsy rate in the PSL-PCNL group do not affect the conclusion that the operation time in the PSL-PCNL group is shorter than that in the TP-PCNL group.…”