Ur Rehman Obaid, Imran Momal, Rafaqat Mudessar, Haider Fayyaz Ur Rahman, Rehman Aveena, Farooq Umer, Changazi Shabbar H, Ur Rehman Fazal
Urology, Ganga Ram Hospital, Lahore, PAK.
Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK.
Cureus. 2023 Feb 23;15(2):e35343. doi: 10.7759/cureus.35343. eCollection 2023 Feb.
Background Because of the anatomical properties of the inferior calyx, lower pole stones are difficult to remove through the ureter, even if the stones are fragmented. Retrograde intra-renal surgery (RIRS) is typically employed to treat the smaller lower pole stones (1.0-2.0 cm) while percutaneous nephrolithotomy (PCNL) is primarily used to treat the larger diameter stones or when RIRS has failed to clear the stones. This study was conducted to compare mini-PCNL and RIRS for the management of lower pole kidney stones in terms of stone clearance. Material and methods This randomized control trial was conducted in the Department of Urology, Shaikh Zayed Hospital, Lahore from October 2020 to December 2022. A total of 150 patients between the ages of 18 and 80 years with a kidney stone size of 10-20 mm at the lower pole were included. Patients with positive urine culture, anatomical abnormalities, uncontrolled diabetes (hemoglobin{Hb}A1c >9%), and undergone previous renal surgery were excluded. Group A patients were treated with mini-PCNL, while group B patients were managed with RIRS. Follow-up visits were planned four weeks postoperatively with CT KUB (computed tomography of kidneys, ureters, and bladder) plain to assess stone clearance. Results The mean age in group A was 43.27 ± 13.86 years, while in group B was 45.32 ± 14.14 years. Out of 150 patients, 102 (68.0%) were males and 48 (32.0%) were females. Mean size of the stone was 15.30 ± 2.21 mm. Stone clearance after mini-PCNL was found in 69 (92.0%) patients and after RIRS in 59 (78.67%) patients (p-value = 0.021). Mean hospital stay after RIRS was 1.1 ± 0.09 days, while it was 2.3 ± 0.64 days after mini-PCNL (p-value < 0.001). Two (2.67%) patients in the mini-PCNL group developed bleeding postoperatively. The stone clearance rate in older patients (51 to 80 years) was significantly higher in the mini-PCNL group than RIRS group. Similarly, the stone clearance rate in female patients and in patients with larger stones (16 to 20 mm) was found to be higher in mini-PCNL group as compared to the RIRS group. Conclusion This study concluded that both mini-PCNL and RIRS are safe and efficient techniques for treating lower pole kidney stones with a size of 11-15 mm. However, mini-PCNL has a higher stone clearance rate compared to RIRS in the treatment of stones larger than 15 mm in size. This study further suggested that patients treated with mini-PCNL had a longer hospital stay compared to patients treated with RIRS.
由于下盏的解剖学特性，即使结石已被粉碎，下极结石也难以通过输尿管取出。逆行肾内手术（RIRS）通常用于治疗较小的下极结石（1.0 - 2.0厘米），而经皮肾镜取石术（PCNL）主要用于治疗直径较大的结石或RIRS未能清除结石的情况。本研究旨在比较迷你PCNL和RIRS在清除下极肾结石方面的效果。
本随机对照试验于2020年10月至2022年12月在拉合尔谢赫扎耶德医院泌尿外科进行。纳入了150例年龄在18至80岁之间、下极肾结石大小为10 - 20毫米的患者。排除尿培养阳性、解剖结构异常、糖尿病控制不佳（糖化血红蛋白{Hb}A1c>9%）以及既往接受过肾脏手术的患者。A组患者接受迷你PCNL治疗，B组患者接受RIRS治疗。术后四周计划进行CT KUB（肾脏、输尿管和膀胱的计算机断层扫描）平扫以评估结石清除情况。
A组的平均年龄为43.27±13.86岁，B组为45.32±14.14岁。150例患者中，102例（68.0%）为男性，48例（32.0%）为女性。结石平均大小为15.30±2.21毫米。迷你PCNL术后结石清除的患者有69例（92.0%），RIRS术后有59例（78.67%）（p值 = 0.021）。RIRS术后平均住院时间为1.1±0.09天，而迷你PCNL术后为2.3±0.64天（p值<0.001）。迷你PCNL组有2例（2.67%）患者术后出现出血。迷你PCNL组老年患者（51至80岁）的结石清除率明显高于RIRS组。同样，女性患者和结石较大（16至20毫米）患者的结石清除率在迷你PCNL组也高于RIRS组。
本研究得出结论，迷你PCNL和RIRS都是治疗大小为11 - 15毫米的下极肾结石的安全有效技术。然而，在治疗大于15毫米的结石时，迷你PCNL的结石清除率高于RIRS。本研究还表明，与接受RIRS治疗的患者相比，接受迷你PCNL治疗的患者住院时间更长。
