Comparison of super-mini-PCNL and flexible ureteroscopy for the management of upper urinary tract calculus (1–2 cm) in children

Jia, Hongliang; Li, Jiuzhi; Liu, Bide; Zhang, Peixin; Yusufu, Ainiwaer; Nan, Yukui; Li, Xun; Wen, Bin; Pu, Chunlin; Du, Wenying; Wang, Shuheng

doi:10.1007/s00345-020-03150-x

Cited by 18 publications

(20 citation statements)

References 16 publications

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“…In the meantime, this study found that the levels of inflammatory factors such as CRP, IL-1, TNF- α , and NF- κ B in the PCNL group were remarkably lower compared to FURL, indicating that PCNL for complex upper urinary tract nephrolithiasis has a lower risk of poor prognosis [ 26 ]. However, there are still some patients whose prognosis is not ideal in the PCNL group.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Yang¹,

Huang

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. A case-control study was conducted to compare the efficacy and prognostic factors of flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) when treating complex upper urinary tract renal calculi based on a retrospective cohort study. Methods. The study period was from October 2019 to December 2021. A retrospective study was carried out on 100 patients with complicated upper urinary tract nephrolithiasis who underwent surgery in the Urology Department of our hospital. They were assigned into two groups: FURL and PCNL groups. The intraoperative blood loss, operation time, hematuria duration, hospital stay, primary stone removal rate, incidence of intraoperative and postoperative complications, VAS score, level of inflammatory factors, and micturition function were compared. According to the postoperative prognosis, the patients were reassigned into two groups: good prognosis group ( n = 38 ) and poor prognosis group ( n = 106 ). The factors related to poor prognosis after FURL and PCNL were screened, and multivariate loglistic regression analysis was adopted to determine the risk factors. Results. The primary stone clearance rate in the PCNL group was significantly higher than that in the FURL group, and there was no significant difference in the incidence of intraoperative and postoperative complications between the two groups ( P > 0.05 ). The intraoperative blood loss and the duration of hematuria in the PCNL group were significantly shorter than those in the FURL group, and the operation time and postoperative hospital stay in the FURL group were longer than those in the FURL group. The postoperative VAS score in the study group was significantly lower than that in the control group ( P < 0.05 ). The levels of CRP, IL-1, TNF-α, and NF-κB in both groups decreased after operation, and the level of inflammatory factors in the PCNL group was significantly lower than that in the FURL group ( P < 0.05 ). The indexes of IPSS and Q max in the PCNL group were significantly lower than those in the control group 3 months after operation. The index of micturition function in the PCNL group was significantly lower than that in the FURL group. Preoperative use of immunosuppressant, preoperative stone fever, positive preoperative urine culture, preoperative urinary leukocyte count ≥ 544 × L , intraoperative urinary opacity, and pus fur were significantly correlated with poor prognosis of ureteral patients ( P < 0.05 ). Preoperative stone fever, high preoperative urinary leukocyte count, intraoperative urinary turbidity, and suppurative fur were independent risk factors for postoperative SIRS in patients with ureteral calculi. Conclusion. PCNL is effective when treating complex upper urinary tract renal calculi. Compared with FURL, PCNL can remarkably reduce intraoperative blood loss and hematuria duration, can enhance micturition function, and will not remarkably increase the incidence of intraoperative and postoperative complications, high safety. High white blood cell count in urine before operation, fever due to stone before operation, turbid urine, and purulent fur during operation are independent risk factors for postoperative adverse outcome in patients with complex upper urinary tract renal calculi. Patients should be fully treated before surgery.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Yang¹,

Huang

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…On the other hand, the miniaturization of percutaneous scopes and access sheaths, combined with the recent introduction of aspirating sheaths, has made PCNL less invasive and more efficient, and also attractive for smaller stones. Jia et al reported a better SFR, a lower retreatment rate, and a lower complication rate for SMP with respect to RIRS for pediatric upper urinary tract stones between 1 and 2 cm [ 88 ]. In a similar stone size range (<2 cm), a randomized controlled study demonstrated that SMP is equally effective but safer than standard PCNL [ 89 ].…”

Section: Discussionmentioning

confidence: 99%

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

Lorenzis

Zanetti

Boeri

et al. 2022

JCM

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Background: Percutaneous nephrolithotomy (PCNL) and its miniaturized modifications are usually considered the standard surgical options for large (>20 mm) staghorn and infected stones. Moreover, PCNL is a viable alternative to retrograde intrarenal surgery (RIRS) for smaller stones (<20 mm) in the presence of anatomical malformations or inaccessible lower pole stones. However, due to the advancements in laser and scope technology, RIRS is expanding its indications with the potential benefits of lower complications and a shorter hospital stay. Methods: A literature search using the PUBMED database from inception to June 2022 was performed to explore the current role of PCNL in endourology. The analysis involved a narrative synthesis. Results: PCNL confirmed its role in the treatment of large and complex stones; moreover, miniaturized PCNL has become more competitive, gaining space among classic indications of flexible ureteroscopy. Conclusions: considering all the evaluated subgroups, we can conclude that PCNL is an old fascinating procedure and is here to stay.

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“…In adults, there is a trend to use progressively smaller Amplatz sheaths for PNL, and therefore it might be expected that for children, smaller sheaths down to 12Ch/Fr would be used [17]. Tubeless PNL in well-selected cases has been performed and is safe [18].…”

Section: Discussionmentioning

confidence: 99%

“…Of the respondents, 87.8% (n = 65) utilized SWL for the treatment of stones < 1 cm, in line with EAU guidelines, correlating with availability (65/74 respondent centres). This renders approaches, such as PNL, which is more likely to yield complete stone clearance in one session, a more attractive option for experienced urologists even with small stones [17]. This is further highlighted, considering the evolution to mini and micro PNL proving optimal safety with fewer complications and high efficiency with low residual fragment rates [5,12,18].…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence of Paediatric Urolithiasis: An EAU Members’ Survey and Expert Panel Roundtable Discussion

Marco

Haid²,

Radford

et al. 2022

Children

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Background: Paediatric nephrolithiasis has increased globally, requiring standardized recommendations. This study aims to assess the paediatric urolithiasis care between EAU members along with the statements of three experts in this field. Methods: The results of an electronic survey among EAU members comparing the guideline recommendations to their current practice managing paediatric nephrolithiasis in 74 centres are contrasted with insights from an expert-panel. The survey consisted of 20 questions in four main sections: demographics, instrument availability, surgical preferences and follow-up preferences. Experts were asked to give insights on the same topics. Results: A total of 74 responses were received. Computerised Tomography was predominantly used as the main imaging modality over ultrasound. Lack of gonadal protection during operations was identified as an issue. Adult instruments were used frequently instead of paediatric instruments. Stone and metabolic analysis were performed by 83% and 63% of the respondents respectively. Conclusions: Percutaneous Nephrolithotomy is the recommended standard treatment for stones > 20 mm, 12% of respondents were still performing shockwave lithotripsy despite PNL, mini and micro-PNL being available. Children have a high risk for recurrence yet stone and metabolic analysis was not performed in all patients. Expert recommendations may guide clinicians towards best practice.

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Comparison of super-mini-PCNL and flexible ureteroscopy for the management of upper urinary tract calculus (1–2 cm) in children

Cited by 18 publications

References 16 publications

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

Guideline Adherence of Paediatric Urolithiasis: An EAU Members’ Survey and Expert Panel Roundtable Discussion

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