A Comparative Study of Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for the Management of Staghorn Renal Calculi.

AIM: The indications for performing retrograde intrarenal surgery (RIRS) have increased. However, no comparative studies have been conducted on the treatment of staghorn renal calculi using RIRS and percutaneous nephrolithotomy (PCNL). We aimed to compare the effectiveness and safety of RIRS and PCNL as treatments for staghorn renal calculi. METHODS: We conducted a retrospective analysis of patients with staghorn renal calculi who underwent either PCNL or RIRS at our hospital from January 2021 to July 2023. Patients with staghorn renal calculi and renal malformation, as well as those with interrupted treatment or irregular follow-up, were excluded from the study. We compared the perioperative outcomes and complications between the groups. RESULTS: Fifty patients were included in the RIRS group, whereas 48 patients were included in the PCNL group. 1. No significant differences were observed between the groups regarding the number of complete staghorn calculi, stone size, age, sex, or other demographic characteristics. 2. RIRS was associated with a shorter postoperative hospitalization time (2.14 ± 0.76 vs. 5.15 ± 1.98 days, p < 0.001). 3. RIRS was associated with a decrease in hemoglobin (0.1 [0, 0.2] vs. 0.65 [0.4, 1] g/dL, p < 0.001) and a lower pain score (1 [1, 2] vs. 2 [1, 3], p = 0.008). 4. Compared with PCNL, RIRS did not significantly differ in terms of the 1-stage stone-free rate (50% vs. 66.67%, p = 0.095) or total stone-free rate (84% vs. 89.58%, p = 0.415). 5. The overall complication rate was lower in the RIRS group (10% vs. 16.67%, p = 0.331). CONCLUSIONS: Compared with PCNL, RIRS can reduce bleeding and overall complications, shorten the hospitalization time, and achieve satisfactory stone-free rate. As a result, RIRS can be considered an alternative treatment option for staghorn renal calculi.

A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy.

BACKGROUND: Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. OBJECTIVE: To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). METHOD: Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. RESULTS: A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. CONCLUSION: Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.