Department of Urology, The University of Hong Kong-Shenzhen Hospital, 518053 Shenzhen, Guangdong, China.
Ann Ital Chir. 2024;95(4):568-574. doi: 10.62713/aic.3474.
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.
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.
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).
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.
逆行性肾内手术（RIRS）的适应证有所增加。然而，目前尚未有研究比较 RIRS 和经皮肾镜碎石术（PCNL）治疗鹿角状肾结石的效果。本研究旨在比较 RIRS 和 PCNL 治疗鹿角状肾结石的有效性和安全性。
我们回顾性分析了 2021 年 1 月至 2023 年 7 月在我院接受 PCNL 或 RIRS 治疗的鹿角状肾结石患者。排除了患有鹿角状肾结石和肾畸形、治疗中断或随访不规律的患者。我们比较了两组患者的围手术期结局和并发症。
RIRS 组 50 例，PCNL 组 48 例。1. 两组完全鹿角结石数量、结石大小、年龄、性别等人口统计学特征无显著差异。2. RIRS 组术后住院时间更短（2.14±0.76 天 vs. 5.15±1.98 天，p<0.001）。3. RIRS 组血红蛋白下降更明显（0.1[0，0.2] g/dL vs. 0.65[0.4，1] g/dL，p<0.001），疼痛评分更低（1[1，2] vs. 2[1，3]，p=0.008）。4. 1 期结石清除率（50% vs. 66.67%，p=0.095）和总结石清除率（84% vs. 89.58%，p=0.415）两组间无显著差异。5. RIRS 组总体并发症发生率较低（10% vs. 16.67%，p=0.331）。
与 PCNL 相比，RIRS 可减少出血和总体并发症，缩短住院时间，获得满意的结石清除率。因此，RIRS 可作为鹿角状肾结石的一种替代治疗选择。
