Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1–2 cm Lower Pole Renal Calculi

Abstract

Objective: To compare the efficacy of new percutaneous technique (“ultra-mini PCNL”, UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1–2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. Materials and Methods: This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1–2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. Results: The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). Conclusions: UMP, FURS, and SWL are all safe and effective in the treatment of 1–2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.

Outcome of Selective Renal Artery Embolization in Managing Severe Bleeding after Percutaneous Nephrolithotomy

“…PCNL is a safe and effective method to treat kidney stones. It has replaced open surgery as the treatment of choice for bulk and complex kidney calculi [10][11][12][13][14][15]. When renal arterial bleeding does occur, the artery can flow into a vein and resulting in an arteriovenous fistula, or into renal parenchyma or hilar areolar tissue and thus a pseudoaneurysm [10].…”

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

“…Previous studies have shown that UMP and RIRS are both safe and effective in the treatment of medium-sized (1.0-2.0 cm) urinary calculi, the SRF immediately after surgery was high (UMP, 84%; RIRS, 87%) [12]. Zhang et al reported that the 3-months SRF of UMP and RIRS in the treatment of 1.0-2.0 cm LPSs was 98 and 92%, respectively [13]; while SFR for these methods in the treatment of 1.0-3.5 cm renal stones was 92 and 96%, respectively [14]. However, the outcomes of UMP and RIRS in the treatment of large LPSs remains inconclusive.…”

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

“…Previous studies have shown that UMP and RIRS are both safe and effective in the treatment of medium-sized (1.0-2.0 cm) urinary calculi, the SRF immediately after surgery was high (UMP, 84%; RIRS, 87%) [12]. Zhang et al reported that the 3-months SRF of UMP and RIRS in the treatment of 1.0-2.0 cm LPSs was 98% and 92%, respectively [13]; while SFR for these methods in the treatment of 1.0-3.5cm renal stones was 92% and 96%, respectively [14]. However, the outcomes of UMP and RIRS in the treatment of large LPSs remains inconclusive.…”