Objective We investigated the surgical efficiency and cut-off criteria to determine whether retrograde intrarenal surgery (RIRS) or supine miniaturized percutaneous nephrolithotomy (MPCNL) is appropriate for managing renal stones with a mean size > 10 mm.
Materials and Methods Data of a single session RIRS or supine MPCNL was collected in a prospective, observational study. Change point analysis with a cumulative sum of ordered value of fragmentation efficiency and stone size was used to detect the point at which the statistical properties of a sequence of observation changes. Results A total of 310 RIRS and 66 MPCNL cases were included. No differences in patient characteristics were observed between the groups. Stone burden, fragmentation efficiency, stone distribution, and the presence of staghorn stones were higher in MPCNL group than those in RIRS group. Stone-free rates and complication rates were not different. The fragmentation efficiency increased to 40.4 ml/min, at which the stone size in RIRS group was 19.1 mm. The efficiency was decreased after the peak point and became the same at the stone size 30 mm with 10mm in RIRS group. The fragmentation efficiency in MPCNL group continuously increased until the size of 35.1 mm. Conclusions RIRS shows the highest efficiency at the maximal diameter of 19.1 mm and the volume of 15,000 mm3. The acceptable level of stone size and volume for RIRS would be 30.0 mm and 27,000 mm3. However, MPCNL would be appropriate when surgeons want to get high surgical efficiency for renal stone > 21.6 mm instead of RIRS.
Journal of endourology. 2017 Aug 02 [Epub ahead of print]
Juhyun Park, Sohee Oh, Min Chul Cho, Hwancheol Son, Hyeon Jeong, Chang Wook Jeong, Jong Jin Oh, Sung Yong Cho
SMG-SNU Boramae Medical Center, Urology , 20, Boramae-ro 5-gil , Dongjak-gu , Seoul , Korea (the Republic of) , 156-707 ; ., SMG-SNU Boramae Medical Center, Biostatistics, Seoul, Korea (the Republic of) ; ., Dongguk University College of Medicine, Urology , 814, Siksa-dong, ilsandong-gu , Goyang, Gyeonggi-do, Korea, Republic of , 410-773 ; ., Seoul National University Boramae Hospital, Urology , Sindaebang 2-dong, 425, Dongjak-gu , Seoul, Korea, Republic of , 156-707 ; ., SMG-SNU Boramae Medical Center, Urology , 1 , Seoul , Korea (the Republic of) , 156-707 ; ., College of Medicine, Seoul National University, Department of Urology , 101 Daehak-ro, Jongno-gu , Seoul, Korea, Republic of , 110-744 ; ., CHA Bundang Medical Center, CHA University, Urology , 351 Yatap-dong, Bundang- , Seongnam-si, Korea, Republic of , 463-712., SMG-SNU Boramae Medical Center, Urology, Seoul , Korea (the Republic of) ; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/28766960
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