Comparative study of clinical effect of percutaneous nephrolithotomy and flexible ureteroscope lithotripsy in the treatment of renal calculus ≤2 cm

Abstract

Objective To compare the effect, postoperative inflammatory response, stress response differences of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of renal calculus with a diameter ≤2 cm. Methods One hundred and twenty-eight patients with renal calculus ≤2 cm m in Beijing Pinggu Hospital were enrolled in the study and were randomly divided into PCNL group(64 cases) and FURL group (64 cases). The treatment of PCNL and FURL was carried out respectively.The stone clearance rate, operation time, hospitalization time, the number of painkillers used after surgery, inflammatory index (hs-CRP, IL-6), oxidative stress index (MDA, SOD) were compared. Results There was no significant difference in the stone clearance rate between PCNL group and FURL group (χ2=0.208, P>0.05). The operation time of PCNL group was (55.32±5.80) min, which was shorter than that of FURL group ((65.21±4.24) min), the difference was statistically significant (t=16.322, P<0.01). The hospitalization time of FURL group was (4.50±1.20) d, which was shorter than that of FURL group ((7.40±1.80)), the difference was statistically significant (t=9.441, P<0.01). The number of painkillers used after surgery in the FURL group was (0.35±0.14) times, which was less than that in FURL group ((0.85±0.24) times), the difference was statistically significant (t=8.625, P<0.01). The postoperative hs-CRP of FURL group (10.62±1.26) mg was significantly lower than that in PCNL group (19.42±1.35) mg/L, The difference was statistically significant (t=12.734, P<0.01). The postoperative IL-6 of FURL group was(31.50±6.57) ng/L, significantly lower than the PCNL group(38.72±6.25) ng/L, the difference was statistically significant (t=5.839, P<0.01). The postoperative MDA of FURL group (0.63±0.17) mmol/L was significantly lower than that of the PCNL group (0.80±0.20) mmol/L, The difference was statistically significant (t=4.288, P<0.01). The postoperative SOD of FURL group (80.40±5.80) U/L was significantly higher than the PCNL group(74.30±7.40) U/L, the difference was statistically significant (t=4.691, P<0.01). The incidence of postoperative complications in PCNL group was 10.94% (7/64), FURL group was 2.17% (1/64), the difference was statistically significant (χ2=4.800, P<0.01). Conclusion FURL has the characteristics of less intraoperative blood loss, less trauma, less postoperative pain and fewer complications in the treatment of renal calculus ≤2 cm, which has less smaller inflammation, oxidative stress, and conducive to the patients′ postoperative recovery. Key words: Renal calculus; Percutaneous nephrolithotomy; Flexible ureteroscopic lithotripsy; Inflammatory reaction; Oxidative stress