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The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis

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Abstract

Purpose

To compare the treatment outcomes between retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MPCNL) for the management of stones larger than 2 cm in patients with solitary kidney.

Methods

Between December 2012 and March 2014, 53 patients with a solitary kidney suffering from urinary stones larger than 2 cm were treated with RIRS. The outcomes of these patients were compared to a cohort of similar solitary kidney stone patients who underwent MPCNL using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: size, number and location of stones, age, BMI, gender and previous ipsilateral open surgery.

Results

A stone-free rate (SFR) of 43.4 % was achieved after a single procedure in patients treated with RIRS and a SFR of 71.70 % in patients treated with MPCNL (p = 0.003). The operative time for RIRS was longer (p = 0.002), but the median hospital stay was shorter (p < 0.001). Average drop in hemoglobin level was comparable in both groups (9.30 vs. 10.85 g/L, p = 0.35). The transfusion rate as well as the incidence of postoperative complications such as fever and urosepsis was not statistically different between these two groups. Major complications (Clavien score 3a–4a) occurred in 3.77 and 1.89 %, RIRS and MPCNL, respectively (p = 1.000).

Conclusions

Patients with a solitary kidney suffering from stones larger than 2 cm in size who undergo MPCNL had a higher SFR than RIRS. The complications were comparable in both groups. Even though RIRS patients spent less time in hospital, this procedure might not be an effective treatment as MPCNL in solitary kidneys with larger and multiple stones.

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Acknowledgments

This work was financed by a Grant from National Natural Science Foundation, China (No. 81370804 and No. 81170652), Colleges and universities in Guangzhou Yangcheng scholars research Project (No. 12A017S), and Science and technology project in Guangzhou (the people’s livelihood special major science and Technology, No. 201300000096).

Conflict of interest

The authors of this study disclose no conflicts of interest.

Ethical standard

The authors have abided by the statement of ethical standards for manuscripts submitted to World Journal of Urology. All persons gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China

    Guohua Zeng, Wei Zhu, Jiasheng Li, Zhijian Zhao, Tao Zeng, Chenli Liu, Yang Liu, Jian Yuan & Shaw P. Wan

  2. Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China

    Guohua Zeng, Wei Zhu, Jiasheng Li, Zhijian Zhao, Tao Zeng, Chenli Liu, Yang Liu, Jian Yuan & Shaw P. Wan

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  1. Guohua Zeng
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  2. Wei Zhu
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  3. Jiasheng Li
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  5. Tao Zeng
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  7. Yang Liu
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Correspondence to Guohua Zeng.

Additional information

Guohua Zeng, Wei Zhu and Jiasheng Li have contributed equally to this work as the co-first authors.

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Zeng, G., Zhu, W., Li, J. et al. The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol 33, 1159–1164 (2015). https://doi.org/10.1007/s00345-014-1420-4

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  • DOI: https://doi.org/10.1007/s00345-014-1420-4

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