Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm

Schoenthaler, Martin; Wilhelm, Konrad; Hein, Simon; Adams, Fabian; Schlager, Daniel; Wetterauer, Ulrich; Hawizy, Azad; Bourdoumis, Andreas; Desai, Janak; Miernik, Arkadiusz

doi:10.1007/s00345-015-1489-4

Cited by 60 publications

(54 citation statements)

References 12 publications

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“…7 Treatment spendings vary from the surgeon's choice; Schoenthaler et al Reported that endoscopes and disposable materials costs are significantly lower compared with the FURS for a medium size kidney stone. 24 Determination of the treatment modality which is safest, cheapest, most efficient and what criteria should be considered as a priority is unknown. Stone size could be first parameters to define the way.…”

Section: Discussionmentioning

confidence: 99%

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

İlgi¹,

Dalkilinc²,

Kutsal³

et al. 2017

J Reconstr Urol

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To determine optimal patients who appropriate for flexible ureteroscopy (FURS) treatment of kidney stones, and the precise cut-off volume value to regard success of FURS. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We retrospectively analysed; 164 FURS procedures for kidney stone treatment between December 2012-October 2016 at our centre. Stone Free Rates (SFR) of the procedure was controlled with Non-Contrast CT (NCCT) at the end of the first month. The success rate was determined as the absence of stone fragments or clinical insignificant residual fragments <4 mm. Demographic features, clinical findings and outcomes were recorded. Multivariate analyses were performed to find independent factors and ROC curve was plotted to mark threshold points. Patients are classified according to volume as group 1 (under the cut-off value) and group 2 (beyond the cut-off volume). Area Under Curve (AUC) was used to define a relation between Total Stone Volume (TSV) and operative outcomes. R Re es su ul lt ts s: : The mean TSV was 364.6±295.9 mm 3 , and the overall SFR was 124 (75.6%). We identified that TSV beyond the 330 mm 3 volume SFR significantly decrease, operative time and fluoroscopy time remarkably increase as well. The AUC for the TSV and outcomes were 0.743, 0.754, 0.731 respectively. Patients whose TSV smaller than 330 mm 3 were 93 (56.7%) and the rest of patients 51(43.3%) have larger stone volume. SFR is significantly lower and fluoroscopy, the operative time longer in group two patients. C Co on nc cl lu us si io on n: : TSV is the strongest influential factor for the SFR. FURS should be kept in mind firstly for the renal stones TSV <330mm 3 , for larger stones other treatment modalities could be thought. K Ke ey yw wo or rd ds s: : Threshold limit values; kidney calculi; ureteroscopy Ö ÖZ ZE ET T A Am ma aç ç: : Böbrek taşı tedavisinde fleksibl üreterorenoskopi (FURS) tedavisine uygun hastaların belirlenmesi ve FURS tedavisinin başarısını değerlendirmesinde net bir eşik değerinin hesaplanması. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Kliniğimizde Aralık 2012 Ekim 2016 tarihleri arasında böbrek taşı tedavisi için FURS tedavisi uygulanmış 164 vaka geriye dönük tarandı. Yapılan işlemin taşsızlık oranı birinci ayın sonunda çekilen kontrastsız bilgisayarlı tomografi (BT) ile değerlen-dirildi. Başarı oranını belirlerken; BT'de kalkül görülmemesi ya da klinik olarak anlamsız kabul edilen (<4 mm) kalküllerin görülmesi başarı olarak kabul edildi. Demografik özellikler, klinik bulgular ve sonuçlar kayıt altına alındı. Bağımsız faktörleri ve ROC eğrisini belirlemek için çok değişkenli analizler yapıldı. Hastalar taş hacimlerinin eşik değerlerinin üstünde ve altında olmalarına göre iki gruba ayrıldılar. Eğri altında kalan alan, toplam taş hacmi (TTH) ile operasyon sonuçları arasındaki ilişkiyi tanımlamak için kullanıldı. B Bu ul lg gu ul la ar r: : Ortalama TTH 364,6±295,9 mm 3 ve toplam taşsızlık oranı 124 (%75,6) idi. Total taş hacmi 3...

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Section: Discussionmentioning

confidence: 99%

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

İlgi¹,

Dalkilinc²,

Kutsal³

et al. 2017

J Reconstr Urol

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“…All studies included were full-text articles. Among all the studies, RIRS was compared with mini-PCNL in six studies [14][15][16][17][18][19], micro-PCNL in three studies [20][21][22], ultra-mini PCNL in two studies [23,24], and mixture of mini and micro PCNL in one study [25]. Agreement between the two reviewers was 91.67% for quality assessment of articles.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…All studies excluded Kiremit's [25] take age, gender, and stone sizes into considerations, and there is no signification difference between each group. During our research, there were only two small sampled RCTs [16,22] (level of evidence: 2b); eight retrospective studies [14,15,17,19,20,[23][24][25] discussed contemporary series of patients (LE: 3b); three were two prospective studies [18,21], and one of them was matchedpair study [18] (LE: 2b), and the rest [21] was prospective data collection (LE: 3b). As for surgical indications, six studies were about mini-PCNL, three studies about micro-PCNL, two about ultra-mini PCNL, and one study discuss mini-PCNL and micro-PCNL at the same time.…”

Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

“…Nine of nonrandomized articles [14,15,[17][18][19][20][21]23,24] (NOS: 6 or more of 9 points) were thought to be of high quality, the rest one [25] was low (NOS: 3 of 9 points) (Supplementary Table S2), and two RCTs were also high quality (Supplementary Table S3). None of the included trails discussed about allocation concealment.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasive percutaneous nephrolithotomy compared with retrograde intrarenal surgery: a meta-analysis

Li¹,

Zheng²,

Zang³

et al. 2018

biomedicalresearch

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Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are widely used in the management of kidney stones. But the safety and efficiency between these two technologies is still a mystery. This meta-analysis was performed to compare the efficacy as well as safety of Minimally Invasive Percutaneous Procedures (MIPPs) including ultra mini-PCNL, mini-PCNL, and micro-PCNL with RIRS. PubMed, Embase and Scopus were searched, and twelve studies included data on 1207 cases (613 for MIPPs and 594 for RIRS) satisfied the inclusion criteria and were included in this research finally. MIPPs were found to be associated with higher stone-free rate but longer hospital stays, and a larger drop in hemoglobin levels. Difference between MIPPs and RIRS in complication rate, operative time, and total cost were not notable. Given no obvious difference in the complication rate and higher efficacy, our findings suggest that mini-PCNL should be recommended over RIRS for stones>2 cm, and that for stones<2 cm any of MIPPs or RIRS are reasonable.

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“…This new treatment modality seems to be promising for the management of middle-sized stones; however, up to now only a few studies have been published from certain centers reporting the limited number of experiences of the same few surgeons. [10][11][12][13][14][15][16] We report herein the outcomes of the prospective clinical study of UMP compared with the findings cited in the literature. With the surgeons' increased experience using UMP and presentation of series, the role of UMP in the management of renal stones will be more clearly understood.…”

Section: Introductionmentioning

confidence: 99%

The role of ultra-mini percutaneous nephrolithotomy in the treatment of kidney stones

Tepeler

Basibuyuk

Tosun

et al. 2016

Turkish Journal of Urology

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Objective: In our study we aimed to evaluate outcomes of ultra-mini-percutaneous nephrolithotomy (UMP) performed for the treatment of kidney stones. Material and methods:Between October 2014 and September 2015, a single surgeon performed UMP on a total of 49 consecutive patients with symptomatic kidney stones at our center. Pregnants, anticogulant users, patients with bleeding diathesis pyonephrosis, and partial/complete staghorn stones were excluded from the study. Patient characteristics, operative data and postoperative outcomes were assessed in detail. Results:The UMP was performed on 50 (34 right/16 left) renal units of the 48 (28 male/20 female) patients included in this study. The mean age and body mass index was 36.5 (2-83) years and 26.2 (17.6-32.8) kg/m 2 , respectively. Mean stone size was calculated as 22.2 (10-55) mm. The mean durations of the operations and fluoroscopic examination were calculated as 65.4 (20-120) minutes and 89.4 (9-322) seconds, respectively. The mean duration of hospitalization was 1.4 (1-5) days. In 52% of the patients the procedure was terminated tubeless. Mean hemoglobin drop was 0.6 (0-3) g/dL. Our series experienced a 10% complication rate. The UMP procedure was successful in 96% of the renal units at the 1 st month control visit assessment. Conclusion:The outcomes of our study have demonstrated that UMP is an effective and safe treatment modality, especially in the treatment of medium-sized renal calculi.

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Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm

Abstract: UMP and fURS are both safe and effective in the treatment of medium-size urinary stones. Costs for endoscopes and disposable materials are significantly lower in UMP.

Cited by 60 publications

References 12 publications

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

Threshold Point of the Total Stone Volume Matter on Decision of Flexible Ureteroscopy

Minimally invasive percutaneous nephrolithotomy compared with retrograde intrarenal surgery: a meta-analysis

The role of ultra-mini percutaneous nephrolithotomy in the treatment of kidney stones

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