Moretto Stefano, Zazzara Michele, Marino Filippo, Ragonese Mauro, Scarcia Marcello, Gradilone Ugo, Russo Pierluigi, Montesi Marco, Lentini Nicolò, Pastorino Roberta, Ludovico Giuseppe M, Pinto Francesco
Department of Urology, F. Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy -
Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy -
Minerva Urol Nephrol. 2024 Dec;76(6):726-735. doi: 10.23736/S2724-6051.24.06074-9.
The American Urologic Association (AUA) and the European Association of Urology (EAU) guidelines endorse percutaneous nephrolithotomy (PCNL) for symptomatic stones larger than 20 mm despite significant risks such as bleeding and urosepsis. Robotic pyelolithotomy (RPL) is emerging as an appealing alternative to PCNL, particularly for patients with anatomical variations like pelvic or horseshoe kidneys, malrotation, previous unsuccessful PCNL, and congenital renal anomalies such as ureteropelvic junction obstruction (UPJO).
A retrospective observational study was conducted involving patients from Miulli Hospital and A. Gemelli University Hospital between February 2016 and December 2023. Adults with large renal stones, including both pelvic and caliceal stones, who underwent either RPL or PCNL were included. The primary outcome was the Stone-Free Rate (SFR) at 12 months. Secondary outcomes included operative time, estimated blood loss, delta hemoglobin, delta creatinine, hospital stay length, and complications. This study compares the effectiveness and outcomes of PCNL and RPL using Propensity Score-Inverse Probability Treatment Weighting (PS-IPTW) analysis.
No statistically significant differences were found in the 12-month SFR between RPL and PCNL, both in the calyceal-pelvic (73.6% vs. 70.6%; P=0.722) and pelvic groups (91% vs. 91.7%; P=1). Complication rates were also similar between RPL and PCNL in both the calyceal-pelvic (15.4% vs. 14.3%; P=0.856) and renal pelvic groups (27.3% vs. 10.8%; P=0.225, with Clavien-Dindo Grade ≥3 complications in 9% vs. 8.9% and 4.4% vs. 0%, respectively. RPL showed significant advantages in operation time in the pyelocaliceal (P<0.001) and pelvic groups (P=0.006), delta creatinine (P=0.018) in the pyelocaliceal group, and hospital stay length in the pelvic group (P=0.011).
RPL demonstrated similar success and complication rates compared to PCNL, with significantly lower intraoperative time, delta creatinine rate, and hospital stay length. RPL is a safe, effective, and minimally invasive treatment option, particularly valuable for large renal stones in patients with complex anatomy and those requiring concomitant renal reconstructive procedures.
美国泌尿外科学会（AUA）和欧洲泌尿外科学会（EAU）的指南支持对直径大于20mm的有症状结石进行经皮肾镜取石术（PCNL），尽管存在出血和尿脓毒症等重大风险。机器人肾盂切开取石术（RPL）正成为PCNL的一种有吸引力的替代方案，特别是对于有解剖变异的患者，如盆腔肾或马蹄肾、旋转不良、既往PCNL失败以及先天性肾异常，如输尿管肾盂连接处梗阻（UPJO）。
进行了一项回顾性观察研究，纳入了2016年2月至2023年12月期间来自缪利医院和A. 杰梅利大学医院的患者。纳入了患有大肾结石（包括盆腔结石和肾盏结石）且接受了RPL或PCNL的成年人。主要结局是12个月时的无石率（SFR）。次要结局包括手术时间、估计失血量、血红蛋白变化、肌酐变化、住院时间和并发症。本研究使用倾向评分 - 逆概率处理加权（PS - IPTW）分析比较了PCNL和RPL的有效性和结局。
RPL和PCNL在12个月SFR方面没有统计学显著差异，在肾盏 - 盆腔组（73.6%对70.6%；P = 0.722）和盆腔组（91%对91.7%；P = 1）均如此。RPL和PCNL在肾盏 - 盆腔组（15.4%对14.3%；P = 0.856）和肾盂组（27.3%对10.8%；P = 0.225）的并发症发生率也相似，其中Clavien - Dindo分级≥3级并发症分别为9%对8.9%和4.4%对0%。RPL在肾盂肾盏组（P < 0.001）和盆腔组（P = 0.006）的手术时间、肾盂肾盏组的肌酐变化（P = 0.018）以及盆腔组的住院时间（P = 0.011）方面显示出显著优势。
与PCNL相比，RPL显示出相似的成功率和并发症发生率，术中时间、肌酐变化率和住院时间显著更低。RPL是一种安全、有效且微创的治疗选择，对于解剖结构复杂的患者以及需要同时进行肾脏重建手术的大肾结石患者尤其有价值。
