1274 A PROSPECTIVE RANDOMIZED TRIAL COMPARING SAFETY AND EFFICACY OF RETROGRADE INTRARENAL SURGERY (RIRS) VS. TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN MANAGEMENT OF MEDIUM SIZED RENAL CALCULI (11-20 MM DIMENSION)

Abstract

You have accessJournal of UrologyTechnology & Instruments: Ureteroscopy1 Apr 20101274 A PROSPECTIVE RANDOMIZED TRIAL COMPARING SAFETY AND EFFICACY OF RETROGRADE INTRARENAL SURGERY (RIRS) VS. TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN MANAGEMENT OF MEDIUM SIZED RENAL CALCULI (11-20 MM DIMENSION) Hemendra Shah, Manju Jain, Rajesh Verma, and Manish Bansal Hemendra ShahHemendra Shah More articles by this author , Manju JainManju Jain More articles by this author , Rajesh VermaRajesh Verma More articles by this author , and Manish BansalManish Bansal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.845AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the recent advances and miniaturization of endoscopes and development of holmium laser lithotripsy, retrograde intrarenal surgery (RIRS) is gaining increasing role in the treatment of renal calculi. The aim of this study was to evaluate role of RIRS vs. tubeless PCNL in management of medium sized renal calculi (11-20 mm dimension). METHODS From May 2008 onwards, all adult patient's with renal calculi 11-20 mm in largest dimension, who chose endoscopic stone management were randomized to undergo either RIRS or tubeless PCNL at our institution. Patients opting for SWL and those not consenting for trial were excluded from study. It was our hypothesis that PCNL will be associated with better stone free rates than RIRS. A power calculation using á = 0.05 and â = 0.02 indicated that to show 10% difference in above parameter, a sample size of 30 individuals per group would be required. Randomization was done by balanced block randomization method. Patients demographic and perioperative data were analyzed. Stone free status was determined by post-operative NCCT scan done at 3-4 week interval. RESULTS Patients demographic data in both groups were comparable (table 1). RIRS was associated with longer operating time (48.33 vs. 36 minutes; p=0.00), inferior stone free rate (33.33% vs. 81.25%), and higher ancillary treatment requirement (9 vs. 1 patient). Although complications rates were comparable amongst both groups, RIRS was associated with higher incidence of postoperative fever. Table 1. Results- Parameter Tubeless PCNL group RIRS group P value Demographic data No. of patients planned to undergo procedure 32 39 No. of patients completing planned procedure 32 33 Age (years) 42.28±12.27 44.96±12.61 0.824 Sex (M : F) 22:10 19:14 0.351 Associated medical Co-morbidities 9 10 0.847 Creatinine (mg%) 1.14±0.26 1.25±0.26 0.097 Size of Stone (mm) 14±3.91 13.55±2.23 0.566 Intraoperative data Duration of Surgery (min) 36.00±6.81 48.33±12.55 0.000 Postoperative data Hemoglobin drop (gm%) 0.65±0.45 0.25±0.21 0.000 Hospital Stay (Hours) 24.71±5.00 27.18±7.58 0.129 Stone related outcome 0.003 Stone Free 26 13 Residual Fragment >4mm 5 17 Residual Fragment <4mm 1 3 Ancillary Procedure 1 9 0.007 Complications 4 9 0.137 Fever 3 9 Sepsis 1 3 Blood transfusion 0 0 Hydrothorax treated conservatively 1 0 Urinoma 0 1 CONCLUSIONS This randomized control trial confirms lower stones free rates with RIRS as compared to tubeless PCNL. However, other large, preferably multicentric trials are needed to define proper role of RIRS in management of medium sized renal calculi. Mumbai, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e493-e494 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hemendra Shah More articles by this author Manju Jain More articles by this author Rajesh Verma More articles by this author Manish Bansal More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...