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Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of stones(>2 cm) in patients with a solitary kidney
Xu Mingbin, Li Chengyang, Chen Jiwen, Liao Naikai, Qin Lei, Chen Cankun, Zhao Jiawen
Published 2019-09-15
Cite as Int J Urol Nephrol, 2019,39(5): 769-772. DOI: 10.3760/cma.j.issn.1673-4416.2019.05.001
Abstract
ObjectiveTo compare the clinical efficacy of percutaneous neprolithotomy (PCNL) and flexible ureteroscopy (FURS) in the treatment of 2.0-4.5 cm stones in a solitary kidney.
MethodsWe retrospectively analyzed 80 cases of calculi in solitary kidney from August 2012 to May 2018, the sizes of the stones were 2.0-4.5 cm, 43 patients underwent PCNL and 37 patients underwent FURS. The patients'characteristics, stone features, operative time, postoperative hospital stay, hospitalization cost, incidence complications, stone-free rate and renal functions have been evaluated.
ResultsThe clinical characteristic of the two groups were comparable.The operative time of PCNL group (103±36) min was shorter than that of FURS group (120±31)min (P=0.039). The postoperative hospitalization stay of PCNL group (9.7±5.1) d was longer than that of FURS group (2.3±1.2) d (P<0.001). The average hospitalization expenses of the PCNL group (29796±10054)yuan were higher than that of the FURS group (19320±7546)yuan (P<0.001). The mean postoperative hemoglobin level of PCNL group (9.3±14.6) g /L was higher than that of FURS group (3.3±3.6)g /L (P=0.014). The postoperative blood transfusion rate of PCNL group was higher than that of FURS(P=0.010). There were 14 cases (32.5%) in the PCNL group using hemostatics after surgery, whereas there was nobody use hemostatics in FURS group, which was statistically significant(P<0.001). Eleven patients (25.6%) and 2 patients (5.4%) of postoperative were treated with pain reliever(P=0.015). There were 7 patients have fever in PCNL group and 4 cases in FURS group (P=0.479). There were no cases of urinary sepsis in either group.The rate of one-session stone removal of PCNL group (86%) was higher than that of FURS (68%) (P=0.048), but there was no significant difference between the two groups in total stone removal rate(P=0.524). Both the levels of serum creatine (Scr) and BUN in the PCNL group decreased after surgery, but only the change of BUN level had statistically significant(P=0.006). There was no statistically significant in the FURS group(P>0.05).
ConclusionsBoth percutaneous nephrolithotomy and flexible ureteroscopy are effective methods for 2.0-4.5 cm stones in a solitary kidney, PCNL has a higher rate of the stone-free rate than FURS, but FURS has less complications, and shorter postoperative hospital stay.
Key words:
Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopy
Contributor Information
Xu Mingbin
Department of Urology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
Li Chengyang
Chen Jiwen
Liao Naikai
Qin Lei
Chen Cankun
Zhao Jiawen