Aim:Advances in the technology of ureteroscopes and lithotriptors have led to implementation of retrograde intrarenal surgery (RIRS) in the treatment of renal stones.The aim of this study was to compare the outcomes and complications of semirigid ureterorenoscopy and percutaneous nephrolithotomy for the treatment of renal pelvic stones between 2-4 cm, retrospectively.
Material and methods:Between January 2014 and July 2016, 90 patients with single renal pelvic stones of 2-4 cm in diameter were treated either by PCNL (group 1) or s-URS (group 2). Group 1 had 44 and group 2 had 46 patients. Demographic features of patients such as age,gender,BMI as well as stone size were compared. Perioperative course and postoperative outcomes such as stone free and complication rates were also evaluated.Patients assessed using a plain abdominal radiography 24 hours after surgery and non-contrast computed tomography at 3rd months, postoperatively.Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <2 mm.
Results:Mean ages of patients in group 1 and 2 were 40.29±19.78 and 38.41±23.26 year, respectively (p=0.681). Two groups were comparable in terms of gender, BMI, grade of hydronephrosis and laterality. Mean stone sizes were also similar in both groups. Mean operation, fluoroscopy and hospitalization times were significantly shorter in group 2. After first sessions, mean stone-free rates for PCNL and s-URS were 81.8% and 60.8%, respectively (p=0.037). In s-URS group, 11 patients underwent f-URS due to stone migration into lower calix and seven of them became stone -free after those procedures. At third months of follow-up, those rates were determined as 84.1% and 76%, respectively. Complication rates were similar among groups, however, mild complications were more common in group 2.
Conclusions:Although s-URS is not superior to PCNL in the treatment of large renal pelvic stones, it can be used to reach renal pelvis and fragment those stones in selected cases.