Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

Li, Maomao; Yang, Houmeng; Liu, Xiaoming; Qi, Honggang; Weng, Guobin

doi:10.12998/wjcc.v6.i15.931

Cited by 20 publications

(15 citation statements)

References 19 publications

(20 reference statements)

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“…Our results con rmed that PCNL offered a higher SFR than RIRS as well, which was consistent with most published studies [8,20,2]. Zewu et al supposed that the potential reasons for RIRS with a relatively lower SFR may be due to residual fragments that are more likely to represent a cluster of clinically insigni cant fragments and small working channel according literatures [25], as well as a call for the vacuum aspiration stone system for RIRS.…”

Section: Correlation Analysissupporting

confidence: 91%

See 1 more Smart Citation

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

Wang

et al. 2020

Preprint

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Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are both important minimally invasive techniques for the treatment of renal stones. With the progress of technology, the application of procedures has been extended. Current surgery choices are made base on stone size, burden and its locations that might limit the predictability and removal of post-operative residual stones. Despite these surgery techniques are maturely used in clinical practice, the patients’ selection have not been standardized in borderline stone. Some patients might suffer several sessions of surgery if intervene decision are not well-designed. In this single-center study, we aimed to determine whether the Hounsfield Unit (HU) value of no-contrast computer computed tomography (NCCT) might offer better guidance in the selection of RIRS or PCNL in renal stones of 2-3 cm, not only in facilitating the stone disintegration, also in providing the potential optimal and less session of setting with great outcomes. A total of 158 patients with kidney stones (2-3 cm) who underwent PCNL/RIRS from March 2016 to January 2019 were enrolled in this study. Gender, stone sizes, locations, average HU value of stone, surgery time, hospital stay time, stone free rate and complications at the time of hospitalization and 3 month follow-up were measured to identify the surgery efficiency. Upon consideration of HU value, the mean surgery time were significantly decreased in RIRS comparing to cRIRS group (47.73 ± 15.52 versus 72.41 ± 27.71 min, p<0.05). Statistically, the surgery time was strong influenced by the HU values both in RIRS (OR: 93.8, p<0.01) and PCNL (OR, 8.21, p<0.05). HU values proved to have a strong positive relation with surgery time in RIRS while a low positive related in PCNL (p<0.05). Overall, for renal stones of 2-3 cm, RIRS proved to be a safe and efficacious treatment option if HU value and other parameters could be comprehensively accounted. Considering HU value before 2-3cm kidney stone lithotripsy seems to be necessary, which might save the surgery time and reduce the potential risk of renal injury, as even if residual stone were detected post-op, ESWL could also be employed and work efficiently. Some patients might not have to perform several sessions of RIRS. Taken together, individual precision surgery might provide ideal treatment and prognosis for patients requiring long-term continuous clinical procedures.

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Section: Correlation Analysissupporting

confidence: 91%

“…A 4.8F Double-J stent was routinely placed at the end of the operation because of possible edema and other problems that might be caused by the access sheath. For the patients who could not place the access sheaths rightly due to the small diameter of their ureters, and a D-J stent was placed for 2-4 weeks and then perform the surgery [7,8].…”

Section: Rirsmentioning

confidence: 99%

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

Wang

et al. 2020

Preprint

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“…Zeng et al found that super-miniPCNL (SMP) had better SFR and lesser auxiliary procedure rate when compared to RIRS for 1-2 cm lower calyceal stones [14]. Several miniature percutaneous techniques (tract size < 22 Fr) have been introduced to provide a less invasive alternative to conventional PCNL (tract size 24-34 Fr) [15] and provide more efficient stone fragmentation and retrieval compared to RIRS [16][17][18][19][20]. Most miniPCNL techniques achieve stone fragmentation using laser or pneumatic lithotripsy and rely on passive irrigation-based siphoning of small stone fragments.…”

Section: Discussionmentioning

confidence: 99%

Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction

et al. 2021

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Purpose of Review Data are lacking on distribution of size of fragments created with the laser lithotripsy, stone density, and composition. Dust (< 1 mm) and small fragments (1-3 mm) may be too small to be efficiently removed with forceps compared to larger fragments (> 3 mm). We aim to report the size distribution of fragments formed during holmium laser lithotripsy. Recent Findings One hundred ten patients with renal calculi < 3 cm underwent miniPCNL using ClearPetra sheath (Well Lead Medical Co., China) with controllable irrigation and suction system that minimizes fragment dispersion and maximizes fragment aspiration. Moses holmium laser (Lumenis INC, Israel) was used with predefined laser energy settings for lithotripsy. Proportion of fragment size < 1 mm was 46.36 ± 16.68%, 1-3 mm was 28.18 ± 10.01%, and > 3 mm was 25.19 ± 16.18% for the entire cohort. Complete stone clearance at 48 h was achieved in 77.3% cases. The remaining 22.7% patients had complete clearance at 1-month follow-up CT. Summary In all the stone density, volume, and composition groups, majority of fragments created were either < 1 mm or 1-3 mm. Only 25% fragments were > 3 mm that would get aspirated out through the sheath with suction or could be retrieved with forceps. The combination of a high-power holmium laser and suction would help in complete stone clearance with effective aspiration of smaller stone fragments and dust simultaneously during lasing.

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“…However, owing to the accumulation of ureteroscopic surgery experience and the rapid improvement of ureteroscope apparatus, the clinical application of RIRS is more extensive. It has been reported that the SFR can reach 73.6% when RIRS is used to treat the 2.0-3.5 cm kidney stones and 90.2% when used to treat LPSs with a diameter of 1.5-2.5 cm [3,8].…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

Lai

Shah

et al. 2020

BMC Urol

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Background: To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods: A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n = 33) or modified UMP (n = 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p < 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p < 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p < 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p < 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p < 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p = 0.504, p = 0.675). There were no significant differences between the two groups in complications (p = 0.228). Conclusion: For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.

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Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

Cited by 20 publications

References 19 publications

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

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