To compare the safety and efficacy of super-mini-percutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) for the treatment of 1-2 cm lower-pole renal calculi (LPC).
An international multicenter, prospective, randomized, non-blinded controlled study was conducted at 10 academic medical centers in China, India, and Turkey between August 2015 and June 2017. A total of 160 consecutive patients with 1-2 cm LPC were randomized to receive SMP or RIRS. The primary endpoint was stone-free rate (SFR). Stone-free status was defined as no residual fragments of ≥0.3 cm on KUB and ultrasound at 1-day and on CT scan at 3-months after operation. Secondary endpoints included blood loss, operating time, postoperative pain scores, auxiliary procedures, complications and hospital stay. Postoperative follow-up was scheduled in three months. Analysis was by intention-to-treat. The trial was registered at http://clinicaltrials.gov/ (NCT02519634).
The two groups had similar baseline characteristics. The mean [SD] stone diameters were comparable in both groups (1.50 [0.29] cm for SMP group versus 1.43 [0.34] cm for RIRS group, p = 0.214). SMP achieved significantly better 1-day and 3-months SFR than RIRS (1-day SFR 91.2% and 71.2%, P = 0.001; 3-months SFR 93.8% and 82.5%, P = 0.028). The auxiliary rate was lower in the SMP group. RIRS was found to be superior regarding lower hemoglobin drop and less postoperative pain. Blood transfusion was not required in both groups. There was no significant difference in operating time, hospital stay and complication rates between the groups.
SMP was more effective than RIRS to treat 1-2 cm LPC in terms of a better SFR and lesser auxiliary rate. The complications and hospital stay were comparable. RIRS has the advantage of less postoperative pain. This article is protected by copyright. All rights reserved.
BJU international. 2018 Jun 06 [Epub ahead of print]
Guohua Zeng, Tao Zhang, Madhu Agrawal, Xiang He, Wei Zhang, Kefeng Xiao, Hulin Li, Xuedong Li, Changbao Xu, Sixing Yang, J J de la Rosette, Junhong Fan, Wei Zhu, Kemal Sarica
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China., Department of Urology, Centre for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, India., Department of Urology, Zhejiang provincial people's hospital, Zhejiang, China., Department of Urology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China., Department of Urology, Shenzhen People's Hospital, Shenzhen, China., Department of Urology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China., Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China., Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China., Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China., Department of Urology, AMC University Hospital, Amsterdam, The Netherlands., Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey.