Abstract
BackgroundTo compare the treatment outcomes between percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the management of stones larger than 2 cm in patients with solitary kidney.MethodsOne hundred sixteen patients with a solitary kidney who underwent RIRS (n = 56) or PCNL (n = 60) for large renal stones (>2 cm) between Jan 2010 and Nov 2015 have been considered. The patients’ characteristics, stone characteristics, operative time, incidence of complications, hospital stay, and stone-free rates (SFR) have been evaluated.ResultsSFRs after one session were 19.6% and 35.7% for RIRS and PCNL respectively (p = 0.047), but the SFR at 3 months follow-up comparable in both groups (82.1% vs. 88.3%, p = 0.346). The calculated mean operative time for RIRS was longer (p < 0.001), but the mean postoperatively hospital stay was statistically significantly shorter (p < 0.001) and average drop in hemoglobin level was less (p = 0.040). PCNL showed a higher complication rate, although this difference was not statistically significant.ConclusionsSatisfactory stone clearance can be achieved with multi-session RIRS in the treatment of renal stones larger than 2 cm in patients with solitary kidney. RIRS can be considered as an alternative to PCNL in selected cases.
Highlights
To compare the treatment outcomes between percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the management of stones larger than 2 cm in patients with solitary kidney
In the past few years, improvements in endoscopy technology make retrograde intrarenal surgery (RIRS) more attractive, even for special circumstances, which has been used as an alternative option to PCNL for renal stones with a low complication rate [3]
stone-free rate (SFR) after RIRS was achieved in 30% of patients with >2 cm stones and usually needed re-treatment; overall complication rates not related to stone sizes [7]
Summary
To compare the treatment outcomes between percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the management of stones larger than 2 cm in patients with solitary kidney. Especially large stone, are very dangerous for patients with solitary kidney. Percutaneous nephrolithotomy (PCNL) is the mainstay of management for large (> 2 cm) or complicated renal. In the past few years, improvements in endoscopy technology make retrograde intrarenal surgery (RIRS) more attractive, even for special circumstances, which has been used as an alternative option to PCNL for renal stones with a low complication rate [3]. SFR after RIRS was achieved in 30% of patients with >2 cm stones and usually needed re-treatment; overall complication rates not related to stone sizes [7]. Kuroda and coworkers [1] have shown that no significant difference was found in term of the change in glomerular filtration rate after RIRS between patients with solitary kidney and bilateral kidneys
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