Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study

Abstract

Background Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. Material/Methods A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. Results A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6–12 months). There were no medium-term complications reported. Conclusions SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.

Comparison of Minimally Invasive Treatment Methods for Urinary Stones: A Retrospective Analysis

“…Although the postoperative complication rate was higher in the combined group, these complications were minor as seen in the previous studies [15]. Besides, the patients with a stone size of more than 5cm had the most complications.…”

“…The total operative time in the combined group was reasonable as in RIRS and PCNL groups. Several factors have been stated in the literature on the impact of operative time during urological surgery [15,19,20]. One factor that increased the operative time might be time for blood transfusion [19], which was the case in the combined group.…”

“…One factor that increased the operative time might be time for blood transfusion [19], which was the case in the combined group. Another factor that could shorten the operative time might be the surgical technique and experience of the surgeon as well as patients' position during the surgery [15,19]. Moreover, in some other studies combined method demonstrated shorter operative time and it is possibly due to the variation in patient populations and different techniques used [20].…”

One-stage efficacy of single tract minimally invasive ECIRS in the improved prone frog split-leg position for staghorn stones

“…Endoscopic combined intrarenal surgery (ECIRS) is a new technique that can perform PNL and FURS simultaneously, also can reduce the number of access tracts [ 13 ]. Related studies have confirmed that the use of single tract minimally invasive ECIRS (stmECIRS) for staghorn calculi has a high SFR and few postoperative complications [ 14 – 16 ]. ECIRS commonly uses the Galdakao-modified supine Valdivia (GMSV) position and the prone split-leg position [ 17 , 18 ].…”

“…However, the GMSV position has some disadvantages, including the collapse of the pyelocaliceal system, difficulties of renal puncture, and smaller space for instrument manipulation, especially in obese patients [ 19 ]. Urologists are more familiar with the prone position, but in the prone split-leg position, the learning curve is relatively high to find the ureteral orifice and place the flexible ureteroscope sheath by using FURS in the prone position, particularly in men with ureteral stricture [ 16 , 20 ], and the actual operation space of the perineal area is small.…”