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Needle-perc-assisted endoscopic surgery versus retrograde intrarenal surgery for the treatment of 1- to 2-cm lower-pole renal stones in patients with unfavorable infundibulopelvic anatomy: a matched-pair analysis

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Abstract

Purpose

To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy.

Methods

Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student’s t-test, Mann–Whitney U test, and Fisher’s exact test.

Results

The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups.

Conclusion

Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate.

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Availability of data and material

All data and materials supporting the findings of this work are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

Abbreviations

PCNL:

Percutaneous nephrolithotomy

RIRS:

Retrograde intrarenal surgery

NAES:

Needle-perc-assisted endoscopic surgery

LPS:

Lower-pole stone; SFR: stone-free rate

GMSV:

Galdakao-modified supine Valdivia

ECIRS:

Endoscopic combined intrarenal surgery

KUB:

Plain film of kidney, ureter, and bladder

CT:

Computed tomography

IPA:

Infundibulopelvic angle

IL:

Infundibular length

IW:

Infundibular width

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Funding

Supported by the Beijing Natural Science Foundation (Grant no.7222239).

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Authors and Affiliations

  1. Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China

    Boxing Su, Weiguo Hu, Bo Xiao, Yubao Liu, Tianfu Ding, Zhongyue Huang & Jianxing Li

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  1. Boxing Su
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  2. Weiguo Hu
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  3. Bo Xiao
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  4. Yubao Liu
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  5. Tianfu Ding
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  6. Zhongyue Huang
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  7. Jianxing Li
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Contributions

BS developed the protocol, collected the data, analyzed the data, and wrote and edited the manuscript. WH collected the data. BX analyzed the data and edited the manuscript. BY collected the data. TD edited the manuscript and analyzed the data. ZH analyzed the data. JL developed the project, analyzed the data, collected the data, and edited the manuscript.

Corresponding author

Correspondence to Jianxing Li.

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Conflict of interest

The authors have no conflict of interest to declare.

Ethics approval

The research involves human participants. All procedures performed in the study were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Also, this study was approved by the Beijing Tsinghua Changgung Hospital Ethics Committee.

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Written consent was obtained from each patient.

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Su, B., Hu, W., Xiao, B. et al. Needle-perc-assisted endoscopic surgery versus retrograde intrarenal surgery for the treatment of 1- to 2-cm lower-pole renal stones in patients with unfavorable infundibulopelvic anatomy: a matched-pair analysis. World J Urol 42, 330 (2024). https://doi.org/10.1007/s00345-024-04971-w

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