Abstract
ObjectiveTo compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm.Patients and methodsA prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and were performed by 2 experienced high-volume surgeons.ResultsBetween September 2018 and April 2019, 593 patients underwent PCNL and 239 patients had RIRS in two tertiary centers. Among them, 149 patients were included for the final analysis after propensity-score matching out of which 75 patients underwent SMP in one center and 74 patients underwent RIRS in the other. The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs. 89.19%; p = 0.015), and was still higher in Group 1 on POD-30 (98.66% vs. 93.24%, p = 0.092) SFR on both POD-1 and POD-30 for lower pole calculi was higher in Group 1 (100 vs. 82.61%, p = 0.047 and 100 vs 92.61% p = 0.171). The mean (SD) operative time was significantly shorter in Group 1 at 36.43 min (14.07) vs 51.15 (17.95) mins (p < 0.0001). The mean hemoglobin drop was significantly less in Group 1 (0.31 vs 0.53 gm%; p = 0.020). There were more Clavien–Dindo complications in Group 2 (p = 0.021). The mean VAS pain score was significantly less in Group 2 at 6 and 12 h postoperatively (2.52 vs 3.67, 1.85 vs 2.40, respectively: p < 0.0001), whereas the mean VAS pain score was significantly less in Group 1 at 24 h postoperatively (0.31 vs 1.01, p < 0.0001). The mean hospital stay was significantly shorter in Group 1 (28.37 vs 45.70 h; p < 0.0001).ConclusionSMP has significantly lower operative times, complication rates, shorter hospital stay, with higher stone-free rates compared to RIRS. SMP is associated with more early post-operative pain though.
Highlights
Nephrolithiasis is a common urologic disease and a major cause of morbidity spanning all age groups with a significant economic burden
With the new generation of flexible ureterorenoscopes, retrograde intrarenal surgery (RIRS) has emerged as a favored treatment option for lower-volume renal stones
The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs 89.19%, p = 0.015), and higher but not statistically significant on POD-30 (98.66% vs 93.24%, p = 0.092) (Fig. 1)
Summary
Nephrolithiasis is a common urologic disease and a major cause of morbidity spanning all age groups with a significant economic burden. The most prevalent are medium-sized renal stones (10–20 mm) while the best management option for these stones depends upon various factors including, stone size, location, density and calyceal anatomy [1, 2]. Several treatment options have been introduced and matured including PCNL, SWL and RIRS. PCNL is superior to SWL for stone clearance and is not impaired by anatomical factors and stone density. The evolution of SMP in recent years has further optimized effectiveness by decreasing the complications and morbidity of PCNL [3]. With the new generation of flexible ureterorenoscopes, RIRS has emerged as a favored treatment option for lower-volume renal stones. Its effectiveness is significantly dependent on calyceal anatomy and stone density [4]
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