Demirbas Arif, Yazar Veli Mert, Ersoy Erim, Demir Demirhan Orsan, Ozcan Serkan, Karakan Tolga, Doluoglu Omer Gokhan, Resorlu Berkan, Hascicek Ahmet Metin, Gunseren Kadir Omur
Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
Department of Urology, İnegöl State Hospital, Bursa, Turkey.
Urol J. 2018 Nov 17;15(6):318-322. doi: 10.22037/uj.v0i0.4213.
Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit.
Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups.
There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively).
RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.
比较经皮肾镜取石术（PNL）和逆行肾内手术（RIRS）治疗同一肾单位多肾盏及多发肾结石的效率和可靠性。
回顾性分析2011年至2015年间接受肾结石手术患者的记录。纳入同一肾单位不同肾盏存在多发结石的患者。接受PNL和RIRS的患者分别定义为I组和II组。评估治疗组之间的患者标准（年龄、性别）；结石特征；手术时间、透视时间和住院时间；结石清除率和并发症发生率。
PNL组（n = 47）和RIRS组（n = 35）在年龄、性别、BMI、患侧、结石数量、结石定位数量、亨氏单位和结石表面积特征方面无显著差异（P值分别为0.558、0.278、0.375、0.051、0.053、0.064、0.642、0.080）。PNL组的结石清除率为59.6%（n = 28），RIRS组为88.6%（n = 31）（P = 0.004）。I组10例患者（21.3%）和II组1例患者（2.9%）发生了根据改良Clavien分类的1级或2级并发症（P = 0.015）。3A或3B级并发症在两组中相似（P = 0.077）。II组的手术时间、透视时间和住院时间显著更短（P值分别<0.001、<0.001和<0.001）。
在治疗同一肾单位的多肾盏及多发结石时，RIRS比PNL更有效、更可靠，结石清除率更高，并发症发生率更低。
