Comparison of ureteroscopy and percutaneous nephrolithotomy for renal pelvic stones over 2 cm

DOI: 10.4328/JCAM.5404 Received: 26.09.2017 Accepted: 16.11.2017 Published Online:16.11.2017 Printed: 01.01.2018 J Clin Anal Med 2018;9(1): 42-6 Corresponding Author: Faruk Kucukdurmaz; Department of Urology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey. GSM: +905335409307 E-Mail:farukdr@hotmail.com Abstract Aim: Advances in the technology of ureteroscopes and lithotriptors have led to the implementation of retrograde intrarenal surgery (RIRS) in the treatment of renal Stones. This study aimed to compare the outcomes and complications of semirigid ureterorenoscopy (s-URS) and percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic stones larger than 2 cm, retrospectively. Material and Method: Between January 2014 and July 2016, 90 patients with single renal pelvic stones of more than 2 cm were treated by PCNL (group 1) or s-URS (group 2). Group 1 had 44; group 2 had 46 patients. Demographic features of patients such as age, gender, body mass index (BMI) as well as stone size were compared. Perioperative course and postoperative outcomes such as stone-free and complication rates were also evaluated. Patients assessed by plain abdominal radiography 24 hours after surgery and non-contrast computed tomography at 3rd months, postoperatively. Clinical success was defined as stone-free status. Results: Mean ages of patients in group 1 and 2 were 40.29±19.78 and 38.41±23.26 year, respectively (p=0.681). Two groups were comparable in terms of gender, BMI, grade of hydronephrosis. Mean stone sizes were also similar. The mean operation, fluoroscopy and hospitalization times were shorter in group 2. After first sessions, mean stone-free rates for PCNL and s-URS were 81.8% and 60.8%, respectively (p=0.037). In the s-URS group,11 patients underwent f-URS due to stone migration into lower calix, and 7 of them became stone-free after those procedures. At 3rd months follow-up, those rates were determined as 84.1% and 76%, respectively. Discussion: Although s-URS is not superior to PCNL in the treatment of large renal pelvic stones, it can be used to reach renal pelvis and fragment those stones in selected cases.