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World Journal of Urology

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01-12-2011 | Original Article

Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size

Authors: Thomas Knoll, Jan Peter Jessen, Patrick Honeck, Gunnar Wendt-Nordahl

Published in: World Journal of Urology | Issue 6/2011

Abstract

Introduction

The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10–30 mm size.

Materials and methods

fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed.

Results

Patients’ demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III–V) occured in both groups.

Conclusions

Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.

Osman M, Wendt-Nordahl G, Heger K et al (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96:875PubMedCrossRef

Türk C, Knoll T, Petric A et al. (2011) Guidelines on urolithiasis. Online

Nagele U, Schilling D, Sievert KD et al (2008) Management of lower-pole stones of 0.8 to 1.5 cm maximal diameter by the minimally invasive percutaneous approach. J Endourol 22:1851PubMedCrossRef

Lahme S, Bichler KH, Strohmaier WL et al (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40:619PubMedCrossRef

Giusti G, Piccinelli A, Taverna G et al (2007) Miniperc? No, thank you! Eur Urol 51:810PubMedCrossRef

Knoll T, Wezel F, Michel MS et al (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24:1075PubMedCrossRef

Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M (2011) Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 108(6):896–899; discussion 899–900. doi:10.1111/j.1464-410X.2010.09936.x

Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39(3):185–188PubMedCrossRef

Tiselius HG, Ackermann D, Alken P et al (2001) Guidelines on urolithiasis. Eur Urol 40:362PubMedCrossRef

10.

Wendt NG, Trojan L, Alken P et al (2007) Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol 21:1439CrossRef

11.

Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108PubMedCrossRef

12.

Knoll T, Michel MS, Alken P (2007) Surgical Atlas. Percutaneous nephrolithotomy: the Mannheim technique. BJU Int 99:213PubMedCrossRef

13.

de la Rosette JJ, Zuazu JR, Tsakiris P et al (2008) Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 180:2489CrossRef

14.

Osman MM, Alfano Y, Kamp S et al (2005) 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol 47:860PubMedCrossRef

15.

Pearle MS, Lingeman JE, Leveillee R et al (2005) Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 173:2005PubMedCrossRef

16.

Albala DM, Assimos DG, Clayman RV et al (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 166:2072PubMedCrossRef

17.

Hyams ES, Munver R, Bird VG et al (2010) Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol 24:1583PubMedCrossRef

18.

Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal stones larger than 25 cm. J Endourol 23:1395PubMedCrossRef

19.

Srisubat A, Potisat S, Lojanapiwat B et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044

20.

Nagele U, Horstmann M, Sievert KD et al (2007) A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy: an in vitro pressure-measurement and microscopic study. J Endourol 21:1113PubMedCrossRef

21.

Li LY, Gao X, Yang M et al (2010) Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study. Urology 75:56PubMedCrossRef

22.

Wendt-Nordahl G, Trojan L, Alken P et al (2007) Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol 21:1439PubMedCrossRef

23.

Hussain M, Acher P, Penev B et al (2011) Redefining the limits of flexible ureterorenoscopy. J Endourol 25:45PubMedCrossRef

24.

Herrera-Gonzalez G, Netsch C, Oberhagemann K et al (2011) Effectiveness of single flexible ureteroscopy for multiple renal calculi. J Endourol 25:431PubMedCrossRef

25.

Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol 23:1395PubMedCrossRef

26.

Breda A, Ogunyemi O, Leppert JT et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater–is this the new frontier? J Urol 179:981PubMedCrossRef

27.

Mariani AJ (2007) Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 177:168PubMedCrossRef

28.

Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, Berberoglu Y, Muslumanoglu AY (2010) Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol 24(12):1929–1934

29.

Turna B, Stein RJ, Smaldone MC et al (2008) Safety and efficacy of flexible ureterorenoscopy and holmium: YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol 179:1415PubMedCrossRef

30.

Shine S (2008) Urinary calculus: IVU vs. CT renal stone? A critically appraised topic. Abdom Imaging 33:41PubMedCrossRef

31.

Mitterberger M, Pinggera GM, Pallwein L et al (2007) Plain abdominal radiography with transabdominal native tissue harmonic imaging ultrasonography vs unenhanced computed tomography in renal colic. BJU Int 100:887PubMedCrossRef

Title: Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size
Authors: Thomas Knoll
Jan Peter Jessen
Patrick Honeck
Gunnar Wendt-Nordahl
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 6/2011
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-011-0784-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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