Mini-PCNL as good as flexible ureteroscope for managing renal stones: Study

High prevalence, increasing incidence combined with a high recurrence rate of urolithiasis, makes the ideal treatment modality and goal to be elusive. Treatment aims at complete clearance of calculi without any residual fragments, along with pain management and complete eradication of the causative micro-organisms . Percutaneous nephrolithotomy (PCNL) is now being offered as a standard treatment option for patients with complex and fairly large renal stones. Further improvisation of instruments and techniques has resulted in "miniperc" and "ultraperc," which were found to be safe and effective.Surgical treatment has drifted from open surgeries to endoscopic surgeries . Recent developments in PCNL and SWL have made management better . PCNL is minimally invasive procedure for removal of renal stones that are more than two centimeters in size. PCNL has been identified globally for its safety with considerable success rate and reduced complications suitable for all age groups including pediatric cases. It facilitates a direct approach to the calculus and subjects surrounding structures to less trauma.

The researchers aimed to evaluate the efficacy of ambulatory mini percutaneous nephrolithotomy (Mini-PCNL) and flexible ureteroscope (F-URS) in treating 10-20 mm lower calyceal stones using propensity score matching analysis (PSM).

For the study design, a retrospective analysis of 136 adult patients that underwent Mini-PCNL or F-URS for a single lower calyx calculus. Participants that underwent F-URS were allocated to Group I, while those who underwent Mini-PCNL were assigned to Group II. Patients were discharged on the same day and followed up by CT after 3 months. Both groups were matched by stone size and density using propensity stone matching (PSM) and the matched group were further compared.

Results highlighted some key facts.

• Before matching, there were statistical differences in stone size (p=0.02), preoperative hydronephrosis (p=0.004), and Hounsfield Unit (p=0.04) between both groups.
• A logistic regression model was created between independent variables such as stone size and density.
• The new groups following PSM were statistically similar in terms of age, BMI, stone size, and HFU (p=0.43, p=0.74, p=0.49, p=0.36).
• The SFR after PSM was not significantly higher in the Mini-PCNL group than the F-URS group (91.7% vs. 81.7%, respectively p=0.1) while the operative time for the F-URS group was significantly shorter than the Mini-PCNL group 54(49-64.3) min vs. 68.2(62-73.5) min, respectively, p=0.045.

For full article follow the link: 10.1016/j.urology.2021.05.041

Source: Urology