Super‐mini percutaneous nephrolithotomy (<scp>SMP</scp>) vs retrograde intrarenal surgery for the treatment of 1–2 cm lower‐pole renal calculi: an international multicentre randomised controlled trial

Zeng, Guohua; Zhang, Tao; Agrawal, Mukul; He, Xi; Zhang, Wei; Xiao, Kefeng; Li, Hu‐Lin; Li, Xuedong; Xu, Chunbao; Yang, Sixing; Rosette, Jean J.M.C.H. de la; Fan, Junhong; Zhu, Wei; Sarıca, Kemal

doi:10.1111/bju.14427

Cited by 56 publications

(41 citation statements)

References 16 publications

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“…Nevertheless, in light of constant and rapid advances in the field of URS, it seems that superiority, if any, of percutaneous nephrolithotomy in terms of SFR is to be tackled by URS in the years to come. This is well illustrated in the present study where 1–2‐cm stones were treated by URS with a laser power range between 5 and 20 W within 52 min in 50% of all cases and within 75 min in 86.4% of all cases (calculations based on values from Table 2 ).…”

supporting

confidence: 74%

“…We read with interest the article by Zeng et al. comparing super‐mini percutaneous nephrolithotomy (SMP) with ureteroscopy (URS) for treatment of 1–2‐cm lower pole renal calculi. In this prospective randomized controlled trial, SMP achieved significantly higher stone‐free rates (SFRs) than URS on first‐day KUB with ultrasonography (91.2% vs 71.2%) as well as on 3‐month CT (93.8% vs 82.5%).…”

mentioning

confidence: 99%

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Ureteroscopy vs miniaturized percutaneous nephrolithotomy: what and who are we comparing?

Keller

Traxer

2018

BJU International

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supporting

confidence: 74%

mentioning

confidence: 99%

Ureteroscopy vs miniaturized percutaneous nephrolithotomy: what and who are we comparing?

Keller

Traxer

2018

BJU International

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“…The treatment of lower pole renal calculi is a difficult point in urology. As the anatomical structure of the lower calyceal is not conducive for stone excretion, ESWL is less effective in the treatment of LPSs [1,16,17]. Some surgeons believed that either RIRS or PCNL surgery is needed even if the diameter of LPSs is less than 1.0 cm [18].…”

Section: Discussionmentioning

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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“…The treatment of lower pole renal calculi is a difficult point in urology. As the anatomical structure of the lower calyceal is not conducive for stone excretion, ESWL is less effective in the treatment of LPSs [1, 16,17]. Some surgeons believed that either RIRS or PCNL surgery is needed even if the diameter of LPSs is less than 1.0 cm [18].…”

Section: Discussionmentioning

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)

Li¹,

Lai

Shah

et al. 2020

Preprint

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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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Super‐mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1–2 cm lower‐pole renal calculi: an international multicentre randomised controlled trial

Abstract: SMP was more effective than RIRS for treating 1-2 cm LPC in terms of a better SFR and lesser auxiliary procedure rate. The complications and hospital stay were comparable. RIRS has the advantage of less postoperative pain.

Cited by 56 publications

References 16 publications

Ureteroscopy vs miniaturized percutaneous nephrolithotomy: what and who are we comparing?

Ureteroscopy vs miniaturized percutaneous nephrolithotomy: what and who are we comparing?

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

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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