Bilateral Single-session Vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study - 17/09/18

Doi : 10.1016/j.urology.2018.07.015

Mohammed S. ElSheemy ^a,^⁎ , Waleed Ghoneima ^a, Akram A. Elmarakbi ^b, Ahmed M. Al-Kandari ^c, Hamdy Ibrahim ^d, Sunil Shrestha ^e, Sanjay Khadgi ^e
^a Urology Department, Cairo University, Cairo, Egypt
^b Urology Department, Beni-Suef University, Beni-Suef, Egypt
^c Kuwait University, Kuwait City, Kuwait
^d Urology Department, Fayoum University, Fayoum, Egypt
^e Vayodha and Venus International Hospitals, Kathmandu, Nepal

^⁎Address correspondence to: Mohammed S. ElSheemy, M.D., Urology Department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt.Urology Department, Kasr Al-Ainy HospitalsCairo UniversityCairoEgypt

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 September 2018

Abstract

Objective

To compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL.

Patients and Methods

Adult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients and 90 renal units) and prospectively compared vs staged-Mini-PNL (55 patients and 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18-Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy. A semirigid ureteroscope (8.5/11.5 Fr) was used. Mann-Whitney, Student t, chi-square, or Fisher's exact tests were used as appropriate.

Results

Both groups were comparable in characteristics of stones and patients. Stone burden was 3.36 ± 1.61 vs 3.38 ± 1.18 cm² in BSS-Mini-PNL vs staged-Mini-PNL, respectively. Staghorn stones were present in 13.3% vs 8.2% in BSS-Mini-PNL vs staged-Mini-PNL, respectively. There was no significant difference in the number of required tracts (1.34 ± 0.6 vs 1.25 ± 0.51 tract/renal unit) as well as the rate of tubeless Mini-PNL (81.1% vs 85.5%) or stone-free rate (90% vs 92.7%) in BSS-Mini-PNL vs staged-Mini-PNL, respectively. BSS-Mini-PNL had significantly shorter operative time (126.22 ± 37.2 vs 169.63 ± 61.28 minutes), shorter hospital stay (2 [1-8] vs 4 [2-16] days) and higher hemoglobin loss (1.1 [0.1-2.8] vs 0.5 [0.1-2.17] gm/d) than staged-Mini-PNL. The complications profile (17.8% vs 13.6%) and rate of blood transfusion (4.4% vs 3.6%) were comparable in BSS-Mini-PNL vs staged-Mini-PNL, respectively, without significant difference.

Conclusion

BSS-Mini-PNL is comparable to staged-PNL as regard stone-free rate and complications according to the selection criteria of the present study. However, BSS-Mini-PNL is associated with significant reduction in the cumulative operative time and hospital stay, which are reflected on the overall cost.

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Plan

	Conflict of interest: The authors declare that they have no conflict of interest. No Funding Source or industrial links and affiliations
	Financial Disclosure: The authors declare that they have no relevant financial interests.
	This study was approved by the local ethical committee and conforms to the provisions of the Declaration of Helsinki. A written informed consent was obtained from all patients.