Skip to main content
SpringerLink
Log in

Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10–30 mm size.

Materials and methods

fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed.

Results

Patients’ demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III–V) occured in both groups.

Conclusions

Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Osman M, Wendt-Nordahl G, Heger K et al (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96:875

    Article  PubMed  Google Scholar 

  2. Türk C, Knoll T, Petric A et al. (2011) Guidelines on urolithiasis. Online

  3. Nagele U, Schilling D, Sievert KD et al (2008) Management of lower-pole stones of 0.8 to 1.5 cm maximal diameter by the minimally invasive percutaneous approach. J Endourol 22:1851

    Article  PubMed  Google Scholar 

  4. Lahme S, Bichler KH, Strohmaier WL et al (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40:619

    Article  PubMed  CAS  Google Scholar 

  5. Giusti G, Piccinelli A, Taverna G et al (2007) Miniperc? No, thank you! Eur Urol 51:810

    Article  PubMed  Google Scholar 

  6. Knoll T, Wezel F, Michel MS et al (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24:1075

    Article  PubMed  Google Scholar 

  7. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M (2011) Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 108(6):896–899; discussion 899–900. doi:10.1111/j.1464-410X.2010.09936.x

  8. Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39(3):185–188

    Article  PubMed  Google Scholar 

  9. Tiselius HG, Ackermann D, Alken P et al (2001) Guidelines on urolithiasis. Eur Urol 40:362

    Article  PubMed  CAS  Google Scholar 

  10. Wendt NG, Trojan L, Alken P et al (2007) Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol 21:1439

    Article  Google Scholar 

  11. Preminger GM (2006) Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108

    Article  PubMed  Google Scholar 

  12. Knoll T, Michel MS, Alken P (2007) Surgical Atlas. Percutaneous nephrolithotomy: the Mannheim technique. BJU Int 99:213

    Article  PubMed  Google Scholar 

  13. de la Rosette JJ, Zuazu JR, Tsakiris P et al (2008) Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 180:2489

    Article  Google Scholar 

  14. Osman MM, Alfano Y, Kamp S et al (2005) 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol 47:860

    Article  PubMed  Google Scholar 

  15. Pearle MS, Lingeman JE, Leveillee R et al (2005) Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 173:2005

    Article  PubMed  Google Scholar 

  16. Albala DM, Assimos DG, Clayman RV et al (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 166:2072

    Article  PubMed  CAS  Google Scholar 

  17. Hyams ES, Munver R, Bird VG et al (2010) Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol 24:1583

    Article  PubMed  Google Scholar 

  18. Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal stones larger than 25 cm. J Endourol 23:1395

    Article  PubMed  Google Scholar 

  19. Srisubat A, Potisat S, Lojanapiwat B et al (2009) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD007044

  20. Nagele U, Horstmann M, Sievert KD et al (2007) A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy: an in vitro pressure-measurement and microscopic study. J Endourol 21:1113

    Article  PubMed  Google Scholar 

  21. Li LY, Gao X, Yang M et al (2010) Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study. Urology 75:56

    Article  PubMed  Google Scholar 

  22. Wendt-Nordahl G, Trojan L, Alken P et al (2007) Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol 21:1439

    Article  PubMed  Google Scholar 

  23. Hussain M, Acher P, Penev B et al (2011) Redefining the limits of flexible ureterorenoscopy. J Endourol 25:45

    Article  PubMed  Google Scholar 

  24. Herrera-Gonzalez G, Netsch C, Oberhagemann K et al (2011) Effectiveness of single flexible ureteroscopy for multiple renal calculi. J Endourol 25:431

    Article  PubMed  Google Scholar 

  25. Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol 23:1395

    Article  PubMed  Google Scholar 

  26. Breda A, Ogunyemi O, Leppert JT et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater–is this the new frontier? J Urol 179:981

    Article  PubMed  Google Scholar 

  27. Mariani AJ (2007) Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 177:168

    Article  PubMed  Google Scholar 

  28. Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, Berberoglu Y, Muslumanoglu AY (2010) Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol 24(12):1929–1934

    Google Scholar 

  29. Turna B, Stein RJ, Smaldone MC et al (2008) Safety and efficacy of flexible ureterorenoscopy and holmium: YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol 179:1415

    Article  PubMed  Google Scholar 

  30. Shine S (2008) Urinary calculus: IVU vs. CT renal stone? A critically appraised topic. Abdom Imaging 33:41

    Article  PubMed  Google Scholar 

  31. Mitterberger M, Pinggera GM, Pallwein L et al (2007) Plain abdominal radiography with transabdominal native tissue harmonic imaging ultrasonography vs unenhanced computed tomography in renal colic. BJU Int 100:887

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Urology, Klinikum Sindelfingen-Boeblingen Medical Center, University of Tübingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany

    Thomas Knoll, Jan Peter Jessen, Patrick Honeck & Gunnar Wendt-Nordahl

Authors
  1. Thomas Knoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Peter Jessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Honeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunnar Wendt-Nordahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Knoll.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knoll, T., Jessen, J.P., Honeck, P. et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World J Urol 29, 755–759 (2011). https://doi.org/10.1007/s00345-011-0784-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-011-0784-y

Keywords

Search

Navigation