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Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis

  • Urology - Original Paper
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Abstract

Purpose

The effect of combining miniaturization with endoscopic combined intrarenal surgery (ECIRS) is unclear. Thus, we compared the treatment outcomes between minimally invasive ECIRS (mini-ECIRS) using 16.5 Fr percutaneous access sheath and standard ECIRS using 24 Fr access sheath for renal stones

Materials and methods

We retrospectively analyzed consecutive patients who underwent single session mini or standard-ECIRS in the modified Valdivia position for renal stones between April 2009 and May 2016. To adjust for patient characteristics, 77 pairs were matched using preoperative parameters including age, sex, history of febrile urinary tract infection (UTI), stone surface area, number of involved calyces, and staghorn calculi.

Results

The stone free rate (SFR) was similar between mini and standard ECIRS according to non-contrast computed tomography (61.1% vs. 52.0%, p = 0.388). The rate of perioperative complications exceeding grade 2 based on the Clavien-Dindo classification was similar in both groups (19.5% vs. 26.0%, p = 0.442). Severe complications exceeding grade 3 were also similar in both groups (2.6% vs. 3.9%, p > 0.99). Two cases of septic shock were noted in each group. Although there was no difference regarding bleeding-related complications (2.6% vs. 6.5%, p = 0.442), pseudoaneurysm or blood transfusion was not observed in the mini-ECIRS group. Pain visual analog scale values in the perioperative period were lower in the mini-ECIRS group (1.34 ± 1.08 vs. 1.69 ± 1.23, p = 0.062).

Conclusions

This study demonstrated that, compared to standard ECIRS, mini-ECIRS maintained SFR without increasing perioperative complications, tended to reduce postoperative pain and had a potential to reduce bleeding-related complications. This report suggests the advantages of ECIRS miniaturization for renal stones.

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References

  1. EAU (2019) EAU Guidelines: presented at the EAU Annual Congress Barcelona 2019. EAU Guidelines Office, Arnhem

    Google Scholar 

  2. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR (2016) Surgical management of stones: american urological association/endourological society guideline Part I. J Urol 196:1153–1160. https://doi.org/10.1016/j.juro.2016.05.090

    Article  PubMed  Google Scholar 

  3. Suarez-Ibarrola R, Desai JD (2019) Is mini-percutaneous nephrolithotomy the way to go for renal stones? Yes! Curr Opin Urol 29:309–311. https://doi.org/10.1097/mou.0000000000000613

    Article  PubMed  Google Scholar 

  4. Jackman SV, Hedican SP, Peters CA, Docimo SG (1998) Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 52:697–701. https://doi.org/10.1016/S0090-4295(98)00315-X

    Article  CAS  PubMed  Google Scholar 

  5. Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M (2011) Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 186:140–145. https://doi.org/10.1016/j.juro.2011.03.029

    Article  PubMed  Google Scholar 

  6. Güler A, Erbin A, Ucpinar B, Savun M, Sarilar O, Akbulut MF (2019) Comparison of miniaturized percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for the treatment of large kidney stones : a randomized prospective study. Urolithiasis 47:289–295. https://doi.org/10.1007/s00240-018-1061-y

    Article  CAS  PubMed  Google Scholar 

  7. Kamel M, Fawzi A, Ragab A, Desoky E, Ragab A, Omran M, Fawzi A, Shahin A (2017) Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience. Urolithiasis 45:585–589. https://doi.org/10.1007/s00240-017-0966-1

    Article  PubMed  Google Scholar 

  8. Kukreja RA (2018) Should mini percutaneous nephrolithotomy (MiniPNL/Miniperc) be the ideal tract for medium-sized renal calculi (15–30 mm)? World J Urol 36:285–291. https://doi.org/10.1007/s00345-017-2128-z

    Article  PubMed  Google Scholar 

  9. Mhaske S, Singh M, Mulay A, Kankalia S, Satav V, Sabale V (2018) Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter %3c15 mm: A 3-year open-label prospective study. Urol Ann 10:165–169. https://doi.org/10.4103/UA.UA_156_17

    Article  PubMed  PubMed Central  Google Scholar 

  10. Haghighi R, Zeraati H, Ghorban Zade M (2017) Ultra-mini-percutaneous nephrolithotomy (PCNL) versus standard PCNL: A randomised clinical trial. Arab J Urol 15:294–298. https://doi.org/10.1016/j.aju.2017.10.003

    Article  PubMed  PubMed Central  Google Scholar 

  11. ElSheemy MS, Elmarakbi AA, Hytham M, Ibrahim H, Khadgi S, Al-Kandari AM (2019) Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis 47:207–214. https://doi.org/10.1007/s00240-018-1055-9

    Article  PubMed  Google Scholar 

  12. Ruhayel Y, Tepeler A, Dabestani S, MacLennan S, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Türk C, Yuan Y, Knoll T (2017) Tract sizes in miniaturized percutaneous nephrolithotomy: A systematic review from the European Association of Urology Urolithiasis Guidelines Panel. Eur Urol 72:220–235. https://doi.org/10.1016/j.eururo.2017.01.046

    Article  PubMed  Google Scholar 

  13. Kuroda S, Ito H, Sakamaki K, Tabei T, Kawahara T, Terao H, Fujikawa A, Makiyama K, Yao M, Matsuzaki J (2015) Development and internal validation of a classification system for predicting success rates after endoscopic combined intrarenal surgery in the modified Valdivia position for large renal stones. Urology 86:697–702. https://doi.org/10.1016/j.urology.2015.07.002

    Article  PubMed  Google Scholar 

  14. Scoffone CM, Cracco CM, Poggio M, Scarpa RM (2010) Endoscopic combined intrarenal surgery for high burden renal stones. Arch Ital Urol Androl 82:41–42

    PubMed  Google Scholar 

  15. Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, Kubota Y, Matsuzaki J (2012) Ureteroscopy assisted retrograde nephrostomy: A new technique for percutaneous nephrolithotomy (PCNL). BJU Int 110:588–590. https://doi.org/10.1111/j.1464-410X.2011.10795.x

    Article  PubMed  Google Scholar 

  16. Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J (2013) Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium laser lithotripsy: A single-center experience. J Endourol 27:715–721. https://doi.org/10.1089/end.2012.0548

    Article  PubMed  Google Scholar 

  17. Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: A new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403. https://doi.org/10.1016/j.eururo.2008.07.073

    Article  PubMed  Google Scholar 

  18. Papatsoris AG, Masood J, Saunders P (2007) Supine valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236. https://doi.org/10.1111/j.1464-410X.2007.07248_3.x

    Article  Google Scholar 

  19. Voilette PD, Denstedt JD (2014) Standardizing the reporting of percutaneous nephrolithotomy complications. Indian J Urol 30:84–91. https://doi.org/10.4103/0970-1591.124213

    Article  PubMed  Google Scholar 

  20. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  Google Scholar 

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Funding

This study was funded by a grant-in-aid for scientific research (C) 19K09718 (to M. J. and K. M.)

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Authors and Affiliations

  1. Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan

    Kimitsugu Usui, Mitsuru Komeya, Takuo Asai & Junichi Matsuzaki

  2. Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan

    Mitsuru Komeya, Takehiko Ogawa & Masahiro Yao

  3. Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan

    Masataka Taguri

  4. Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Koshi Kataoka

Authors
  1. Kimitsugu Usui
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  2. Mitsuru Komeya
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  3. Masataka Taguri
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  4. Koshi Kataoka
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  5. Takuo Asai
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  6. Takehiko Ogawa
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  7. Masahiro Yao
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  8. Junichi Matsuzaki
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Contributions

KU: project development, data collection, manuscript writing. MK: project development, data collection, manuscript writing. MT: data analysis. KK: data analysis. TA: data collection. TO: project development, manuscript editing. MY: Project development. JM: project development.

Corresponding author

Correspondence to Mitsuru Komeya.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The ethics committee of Ohguchi East General Hospital approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Usui, K., Komeya, M., Taguri, M. et al. Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis. Int Urol Nephrol 52, 1219–1225 (2020). https://doi.org/10.1007/s11255-020-02433-x

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  • DOI: https://doi.org/10.1007/s11255-020-02433-x

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