Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones &gt;1 cm: A Systematic Review and Meta-analysis of Randomized Trials

Dorantes-Carrillo, Luis Alberto; Basulto-Martínez, Mario; Suárez-Ibarrola, Rodrigo; Heinze, Alexander; Proietti, Silvia; Flores-Tapia, Juan Pablo; Esqueda-Mendoza, Antonio; Giusti, Guido

doi:10.1016/j.euf.2021.02.008

“…Upper urinary tract calculus is a common disease for global urologists. Both percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy lithotripsy (FURL) are popular options for treating renal stones [ 1 – 4 ]. PCNL is recommended for kidney stone > 20 mm and FURL for < 20 mm in the guidelines issued by the American Urological Association [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

High stone-free rate immediately after suctioning flexible ureteroscopy with Intelligent pressure-control in treating upper urinary tract calculi

Gao¹,

Zhang²,

Li³

et al. 2022

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Background The retrospective observational study aimed to evaluate the safety and efficacy of suctioning flexible ureteroscopy with Intelligent pressure-control (SFUI) on treating upper urinary tract calculi in a large cohort. Methods Between July 2020 and August 2021, 278 patients with upper urinary tract calculi who underwent SFUI in our hospital were enrolled. Outcomes were stone-free rate (SFR) in one session and one-month after SFUI treatment, and complications scored by the Clavien-Dindo classification. Results A total of 310 kidneys underwent SFUI were included. The median surgery time was 75 min (ranged 60–110 min). One session and one-month SFRs were 80.65% and 82.26%, respectively. The one-session SFR was ≧ 87% in patients with Guy’s stone score of Grade I among stone size < 40 mm. Risk factors for unsuccessful stone-free in one session were stone history (adjusted odds ratio (aOR): 2.39, 95% confidence interval (CI): 1.21–4.73), stone size of 40–49 mm (aOR: 4.37, 95% CI: 1.16–16.45), Guy’s stone score ≧ Grade II (Grade II, aOR: 3.54, 95% CI: 1.18–10.59; Grade III, aOR: 10.95, 95% CI: 2.65–45.25). The incidence of Clavien-Dindo grade II-III complication was 3.26%. Complication is associated with Guy’s stone score III (aOR: 22.36, 95% CI: 1.81–276.36). Conclusion SFUI shows good safety and efficiency on treating upper urinary tract calculi. Patients with stone size < 40 mm or Guy’s stone score of Grade I have a high chance to reach stone-free after SFUI treatment.

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“…Dutta et al communicated this prospective randomized trial in order to figure out which is the best treatment option for midsize stones that fall into a gray area currently present in most of the important guidelines that suggest a percutaneous approach only for stones >2 cm. 1 Although there was already some evidence of the superiority of mini-percutaneous nephrolithotomy (mPCNL), 2,3 I think that the authors should be commended for providing robust evidence that mPCNL, which is not included in AUA guidelines, guarantees a better stone-free rate for this numerous subset of patients without increasing the complication rate as feared by the general understanding of the urological community.…”

Section: Editorial Commentmentioning

confidence: 99%

“…Although there was already some evidence of the superiority of mini-percutaneous nephrolithotomy (mPCNL), 2,3 I think that the authors should be commended for providing robust evidence that mPCNL, which is not included in AUA guidelines, guarantees a better stone-free rate for this numerous subset of patients without increasing the complication rate as feared by the general understanding of the urological community.…”

mentioning

confidence: 99%

Editorial Comment

Giusti

¹

,

Proietti

²

2023

Journal of Urology

0

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“…Dutta et al communicated this prospective randomized trial in order to figure out which is the best treatment option for midsize stones that fall into a gray area currently present in most of the important guidelines that suggest a percutaneous approach only for stones >2 cm. 1 Although there was already some evidence of the superiority of mini-percutaneous nephrolithotomy (mPCNL), 2,3 I think that the authors should be commended for providing robust evidence that mPCNL, which is not included in AUA guidelines, guarantees a better stone-free rate for this numerous subset of patients without increasing the complication rate as feared by the general understanding of the urological community.…”

Section: Editorial Commentmentioning

confidence: 99%