Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy

作者：Kruck Stephan; Anastasiadis Aristoteles G; Herrmann Thomas R W; Walcher Ute; Abdelhafez Mohamed F; Nicklas Andre P; Hoelzle Lillian; Schilling David; Bedke Jens; Stenzl Arnulf; Nagele Udo^*

来源：World Journal of Urology, 2013, 31(6): 1555-1561.

DOI：10.1007/s00345-012-0962-6

• Renal calculi
• Shockwave lithotripsy
• Retrograde intrarenal surgery
• Minimally invasive percutaneous nephrolithotomy
• Outcome

There is a lack of studies comparing shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) in renal stone treatment. This study compared treatment outcome, stone-free rate (SFR) and stone-free survival (SFS) with regard to stone size and localization. %26lt;br%26gt;This analysis included 482 first-time-treated patients in the period 2001-2007. Detailed clinical information, stone analysis and metabolic evaluation were evaluated retrospectively. Outcome, SFR and SFS were analyzed with regard to size (%26lt; 1 vs. a parts per thousand yen1 cm) and localization (lower vs. non-lower pole). %26lt;br%26gt;Higher SFRs in lower and non-lower pole stones a parts per thousand yen1 cm were confirmed for RIRS and MIP (p %26lt; 0.0001). A regression model confirmed a higher risk of non-lower pole stone persistence for SWL versus RIRS (OR: 2.27, p = 0.034, SWL vs. MIP (OR: 3.23, p = 0.009) and larger stone burden a parts per thousand yen1 versus %26lt; 1 cm (OR: 2.43, p = 0.006). In accordance, a higher risk of residual stones was found in the lower pole for SWL versus RIRS (OR: 2.67, p = 0.009), SWL versus MIP (OR: 4.75, p %26lt; 0.0001) and stones a parts per thousand yen1 cm versus %26lt; 1 cm (OR: 3.02, p = 0.0006). In RIRS and MIP patients, more complications, stenting, prolonged disability, need/duration of hospitalization and analgesia were noticed (p %26lt; 0.05). Overall SFS increased from SWL, RIRS, to MIP (p %26lt; 0.001). SWL showed lower SFS for non-lower pole (p = 0.006) and lower pole stones (p = 0.007). %26lt;br%26gt;RIRS and MIP were shown to have higher stone-free rates and SFS compared to SWL. The price for better outcome was higher, considering tolerable complication rates. Despite larger preoperative stone burden, MIP achieved high and long-term treatment success.

• 出版日期2013-12