Which Should be Preferred for Moderate-Size Kidney Stones? Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery?

Demirbaş, Arif; Reşorlu, Berkan; Sunay, Mehmet Melih; Karakan, Tarkan; Karagöz, Mehmet Ali; Doluoğlu, Ömer Gökhan

doi:10.1089/end.2016.0370

Cited by 17 publications

(26 citation statements)

References 27 publications

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“…From a total of 607 studies, 10 were identified which satisfied our pre-defined selection criteria for Mi-PCNL [ 4 ••, 5 – 11 , 12 •, 13 ]. Three of these studies related to micro PCNL (two retrospective studies and one randomised study, published between 2013 and 2015) [ 4 ••, 5 , 6 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three of these studies related to micro PCNL (two retrospective studies and one randomised study, published between 2013 and 2015) [ 4 ••, 5 , 6 ]. The seven remaining articles all described ultra-mini PCNL, also termed UMP (one case series, four cohort studies and two randomised studies, published between 1998 and 2016) [ 7 – 11 , 12 •, 13 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review

et al. 2018

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Purpose of ReviewThe role of PCNL and the expertise surrounding it has expanded in recent decades. Miniaturisation of equipment and instrument size has formed a part of this innovation. Although an increasing number of studies have been performed on miniaturised PCNL (Mi-PCNL) recently, a critical appraisal on these is lacking. We therefore conducted a systematic review of the literature to evaluate the efficacy, safety and feasibility of Mi-PCNL techniques (< 15 Fr).Recent FindingsA systematic review was conducted from 1990 to March 2017 on outcomes of Mi-PCNL [micro PCNL (m-PCNL) and ultra-mini PCNL (UMP)] in adult patients. Ten studies (three on m-PCNL and seven on UMP) were included in our study. Across the three studies, 118 patients (mean age 42.2 years, male to female ratio 1.3:1) underwent m-PCNL (4.8 Fr). For a mean stone size of 13.9 mm, a mean stone-free rate (SFR) was 89% and an overall complication rate was 15.2% [Clavien classification I (44%), II (28%), III (28%)], with no Clavien IV or V complications. Across the seven studies, 262 patients (mean age 49.4 years, male to female ratio 1.5:1) underwent UMP (13–14 Fr). For a mean stone size of 18.6 mm, a mean SFR was 88.3% and an overall complication rate was 6.2% [Clavien classification I (57%), II (36%), III (7%)], with no Clavien IV or V complications. While the transfusion rates for m-PCNL was 0.85%, only one case each in m-PCNL and UMP needed conversion to mini PCNL.SummaryOur review shows that for small- to medium-sized renal stones, Mi-PCNL can yield good stone-free rates whilst maintaining a low morbidity associated with it. There were no Clavien > III complications and no mortality with only one transfusion reported from this minimally invasive technique.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review

et al. 2018

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“…Demirbas compared the efficacy of ultra-mini PCNL (UMPNL) and RIRS in treating moderate-size kidney stones (greatest diameter of 10–25 mm). [ 5 ] SFR was 80% in UMPNL and 74.4% in RIRS ( P > 0.05). They had significantly poor SFRs for lower pole stones with RIRS (43%) as compared to UMPNL (93%).…”

Section: Discussionmentioning

confidence: 89%

“…[ 2 3 ] Retrograde intrarenal surgery (RIRS), also popular as flexible uretero reno scopy (fURS), is less invasive, has fewer complications, and especially, useful in patients with complex anatomical kidneys, patients on anticoagulants, and patients with bleeding diathesis. [ 4 5 ] Success of any modality for stone disease needs to be evaluated in terms of stone-free rates (SFRs), auxiliary procedures needed, complications, and long-term follow-up. SFR in RIRS is subject to multiple parameters such as stone burden, stone location, number of stones, stone hardness (as measured by Hounsfield value on computed tomography CT scan), stone composition, calyceal anatomy, ureter anatomy, use of ureteral access sheath (UAS), and surgeon experience.…”

Section: Introductionmentioning

confidence: 99%

Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases

Parikh¹,

Jain²,

Kandarp³

2018

Urol Ann

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Introduction:Success of any modality for stone disease needs to be evaluated in terms of Stone Free Rates (SFR), auxiliary procedures needed; complications and follow up. SFR in RIRS is subject to parameters like stone burden, location, number, hardness, composition; calyceal and ureter anatomy; use of ureteric access sheath (UAS); surgeon experience etc.Methods:The aim of this study is to evaluate the efficacy and safety of RIRS for managing upper tract stones. The objectives include evaluating SFR in RIRS in relation to stone burden, location and number. Other objectives include evaluating SFR after re RIRS in relation to stone burden, necessity of pre DJ stenting, use of UAS and post operative complication rate. 131 patients operated by single surgeon for single/multiple renal and/or upper ureteric stones were evaluated. Stone size > 3 mm on follow up CT KUB was considered as residual. Re RIRS was required for residual stones.Results:The overall SFR was 76%. SFR were statistically lower with stone burden > 1.5 cm, lower calyceal stones and single stones with stone burden > 1.5 cm. SFR was 90% after 2nd RIRS and 98.5% after 3rd RIRS procedure. No significant difference in SFR was noted between single v/s multiple stones, single calyx v/s multiple calyx stones and renal v/s upper ureteric stones. No major complication was noted.Conclusion:Larger stone burden and lower calyceal location are important factors deciding SFR in RIRS. With auxiliary procedure, RIRS is safe and effective compared to PCNL.

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“…En la búsqueda sistemática sólo se encontró una RS: la realizada para la GPC sobre el manejo de litiasis renal y urolitiasis del NICE (9) . Esta RS encontró 14 ensayos clínicos aleatorizados (10,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) en pacientes con litiasis renal de 10 a 20 mm, los cuales fueron meta-analizados. Si bien la evidencia demuestra cierta superioridad de NLP/URS frente a LEOCH, el GEG consideró que realizar NLP tendría un riesgo significativo de eventos adversos mayores debido a que es un procedimiento invasivo y operador dependiente en cuyo uso se tiene menor experiencia, comparada con los demás procedimientos.…”

Section: Pregunta 2: En Pacientes Con Litiasis Renal De 10 a 20 MM ¿unclassified

Guía de práctica clínica para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud)

et al. 2019

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Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencias para la para el tratamiento quirúrgico de los pacientes con urolitiasis en EsSalud. Método. Se conformó un grupo elaborador de la guía (GEG) constituido por médicos urólogos y metodólogos, los cuales formularon las preguntas clínicas que fueron respondidas dentro de la presente GPC. Para cada una de estas preguntas se realizó búsquedas de revisiones sistemáticas y de estudios primarios (cuando se consideró pertinente) en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas, posteriormente se evaluó la certeza de la evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Se programaron reuniones de trabajo periódicas en las cuales el GEG revisó la evidencia y formuló recomendaciones, puntos de buenas prácticas clínicas y flujogramas usando la metodología GRADE. La GPC fue aprobada con Resolución N° 66–IETSI-ESSALUD-2018. Resultados. Se abordó 6 preguntas clínicas sobre el tema de tratamiento quirúrgico en urolitiasis. En base a dichas preguntas se formularon 5 recomendaciones (2 recomendaciones fuertes y 3 recomendaciones condicionales), 21 puntos de buena práctica clínica, y 3 flujogramas de manejo. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el tratamiento quirúrgico de pacientes con urolitiasis en EsSalud.

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Which Should be Preferred for Moderate-Size Kidney Stones? Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery?

Abstract: Both UMPNL and RIRS procedures are effective and safe methods in treatment of middle-sized renal stones. However, UMPNL is more effective than RIRS in treatment of lower pole stones. RIRS is more advantageous when loss from work is taken into consideration.

Cited by 17 publications

References 27 publications

Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review

Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review

Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases

Guía de práctica clínica para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud)

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