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01-12-2024 | Correspondence

RIRS with FV-UAS vs. MPCNL for 2–3-cm upper urinary tract stones: a prospective study

Authors: Du-Jian Wang, Ping Liang, Tian-Xiao Yang, Yi-Qing Liu, Qing-Lai Tang, Xing-Zhu Zhou, Rong-Zhen Tao

Published in: Urolithiasis | Issue 1/2024

Abstract

To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 2–3 cm upper urinary tract stones. A total of 160 patients with 2–3 cm upper urinary tract stones were prospectively randomized into 2 groups—80 in the FV-UAS group and 80 cases as control in the MPCNL group. The stone-free rates (SFRs) at different times (postoperative 1st day and 4th week) were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay, and operation-related complications. There was no obvious difference between the two groups in patient’s demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in FV-UAS group than that in MPCNL group (5.3 vs. 10.8 g/L, P < 0.001). Postoperative hospital stay in FV-UAS group was more shorten than that in MPCNL group (2.7 vs. 4.9 days, P < 0.001). There was no statistical significance between the two groups in SFRs during postoperative 1st day and 4th week (both P > 0.05). However, in terms of the rates of bleeding and pain, MPCNL group were both significantly higher than FV-UAS group (6.2 vs. 0.0%, P = 0.023; 16.2 vs. 2.5%, P = 0.003; respectively). Our study showed that RIRS with FV-UAS, a new partnership to treat 2–3 cm upper urinary tract stones, was satisfying as it achieved a high SFR rate and a low rate of complications. This method was safe and reproducible in clinical practice.

Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12(2–3):e86-96PubMedPubMedCentral

Tuerk C, Knoll T, Petrik A et al (2015) Guidelines on urolithiasis. European Urological Association Web site. Available at: http://uroweb.org/wp-content/uploads/22-Urolithiasis_LR.pdf.

Li X, He Z, Wu K et al (2009) Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience. J Endourol 23(10):1693–1697CrossRefPubMed

Ghani KR, Sammon JD, Bhojani N et al (2013) Trends in percutaneous nephrolithotomy use and outcomes in the United States. J Urol 190(2):558–564CrossRefPubMed

Erkoc M, Bozkurt M (2021) Comparison of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for renal pelvic stones of 2–3 cm. J Laparoendosc Adv Surg Tech A 31(6):605–609CrossRefPubMed

Resorlu B, Unsal A, Ziypak T et al (2013) Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31(6):1581–1586CrossRefPubMed

Akman T, Binbay M, Ozgor F et al (2012) Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2–4 cm stones: a matched-pair analysis. BJU Int 109(9):1384–1389CrossRefPubMed

Doizi S (2021) Intrarenal pressure: what is acceptable for flexible ureteroscopy and percutaneous nephrolithotomy? Eur Urol Focus 7(1):31–33CrossRefPubMed

Guven S, Yigit P, Tuncel A et al (2021) Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol 39(2):549–554CrossRefPubMed

10.

Tokas T, Herrmann T, Skolarikos A et al (2019) Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 37(1):125–131CrossRefPubMed

11.

Brain E, Geraghty RM, Lovegrove CE et al (2021) Natural history of post-treatment kidney stone fragments: a systematic review and meta-analysis. J Urol 206(3):526–538CrossRefPubMed

12.

Wu ZH, Wang YZ, Liu TZ et al (2022) Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones. World J Urol 40(9):2347–2352CrossRefPubMed

13.

Lai D, He Y, Li X et al (2020) RIRS with vacuum-assisted ureteral access sheath versus MPCNL for the treatment of 2–4 cm renal stone. Biomed Res Int 2020:8052013CrossRefPubMedPubMedCentral

14.

Chen Y, Li C, Gao L et al (2022) Novel flexible vacuum-assisted ureteral access sheath can actively control intrarenal pressure and obtain a complete stone-free status. J Endourol 36(9):1143–1148CrossRefPubMed

15.

Tiselius HG, Andersson A (2003) Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 43(3):275–281CrossRefPubMed

16.

Dauw CA, Simeon L, Alruwaily AF et al (2015) Contemporary practice patterns of flexible ureteroscopy for treating renal stones: results of a worldwide survey. J Endourol 29(11):1221–1230CrossRefPubMed

17.

Tao RZ, Tang QL, Zhou S et al (2020) External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0–2.0 cm after extracorporeal shock wave lithotripsy: a prospective randomized trial. Urolithiasis 48(1):71–77CrossRefPubMed

18.

Yang J, Tao RZ, Lu P et al (2018) Efficacy analysis of self-help position therapy after holmium laser lithotripsy via flexible ureteroscopy. BMC Urol 18(1):33CrossRefPubMedPubMedCentral

19.

Labate G, Modi P, Timoney A et al (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25(8):1275–1280CrossRefPubMed

20.

Desai J, Zeng G, Zhao Z et al (2013) A novel technique of ultra-mini-percutaneous nephrolithotomy: introduction and an initial experience for treatment of upper urinary calculi less than 2 cm. Biomed Res Int 2013:490793CrossRefPubMedPubMedCentral

21.

Hamamoto S, Yasui T, Okada A et al (2014) Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. J Endourol 28(1):28–33CrossRefPubMed

22.

Karakoyunlu AN, Cakici MC, Sari S et al (2019) Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy methods for management of big- sized Kidney stones(≥ 4 cm): single center retrospective study. Urol J 16(3):232–235PubMed

23.

Zhu Z, Cui Y, Zeng F et al (2019) Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol 37(5):921–929CrossRefPubMed

24.

Oratis AT, Subasic JJ, Hernandez N et al (2018) A simple fluid dynamic model of renal pelvis pressures during ureteroscopic kidney stone treatment. PLoS One 13(11):e0208209CrossRefPubMedPubMedCentral

25.

Pearle MS, Lingeman JE, Leveillee R et al (2008) Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 179(5 Suppl):S69-73PubMed

26.

Berardinelli F, De Francesco P, Marchioni M (2016) Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol 48(11):1757–1762CrossRefPubMed

Title: RIRS with FV-UAS vs. MPCNL for 2–3-cm upper urinary tract stones: a prospective study
Authors: Du-Jian Wang
Ping Liang
Tian-Xiao Yang
Yi-Qing Liu
Qing-Lai Tang
Xing-Zhu Zhou
Rong-Zhen Tao
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Published in: Urolithiasis / Issue 1/2024
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI: https://doi.org/10.1007/s00240-024-01539-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

RIRS with FV-UAS vs. MPCNL for 2–3-cm upper urinary tract stones: a prospective study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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