Supine percutaneous nephrolithotomy in impacted proximal ureteral stones larger than 15 millimeters; Comparison of flexible ureterorenoscopy and retroperitoneal laparoscopic ureterolithotomy

Year 2023, , 1 - 8, 30.01.2023

Taner Kargı , Mithat Ekşi , Ali Ayten , Yunus Çolakoğlu , Serdar Karadağ , İsmail Evren , Ahmet Haciislamoğlu , Hakan Polat , Feyzi Arda Atar , Alper Bitkin , Selçuk Şahin , Ali İhsan Taşçı

https://doi.org/10.54233/endouroloji.1140588

Abstract

Objective: We aimed to compare the efficacy and safety of supine mini-percutaneous nephrolithotomy (SMPCNL), retroperitoneal laparoscopic ureterolithotomy (RPUL), and flexible ureterorenoscopy (FURS) in the treatment of impacted proximal ureteral stones larger than 15 mm in diameter.
Material and Methods: Data of the patients who underwent SMPCNL, RPUL, and FURS in our institution for proximal ureteral stones between August 2015 and September 2020 were reviewed. Collected data included age, gender, body mass index (BMI) and hydronephrosis grade, stone density, duration of surgery, hospital stay and recovery period, stone-free and demographic data such as complication rates and duration of surgery.
Results: Overall, 162 patients were included. Of these patients, 52 (32.1%) were in Group 1 (SMPCNL group), 53 (32.7%) were in Group 2 (RPUL group), and 57 (35.2%) ) were in Group 3 (FURS group). Mean operative times were 53±8.2 minutes in Group 1, 63.2±6.6 minutes in Group 2, and 73.7±7.5 minutes in Group 3 (p=0.000). The mean hospital stay was significantly shorter in Group 3 compared to the other groups (p=0.000). The stone-free rates at the initial evaluation were 100%, 90.3%, and 87.7% in the RPUL, SMPCNL, and FURS groups. This rate was significantly lower in the FURS group compared to the other groups (p=0.02).
Conclusion: SMPCNL and RPUL procedures are as safe as FURS in treating patients with proximal ureteral stones larger than 15 mm.

Keywords

supine, percutaneous nephrolithotomy, large impacted proximal ureteral stones

15 milimetreden büyük impakte proksimal üreter taşlarında supin perkütan nefrolitotomi; Fleksible üreterorenoskopi ve retroperitoneal laparoskopik üreterolitotominin karşılaştırılması

Abstract

Amaç: Çapı 15 mm’den büyük gömülü proksimal üreter taşlarının tedavisinde sırtüstü mini-perkütan nefrolitotomi (SMPCNL), retroperitoneal laparoskopik üreterolitotomi (RPUL) ve fleksibl üreterorenoskopinin (FURS) etkinlik ve güvenliğini karşılaştırmayı amaçladık.
Gereç ve Yöntemler: Ağustos 2015-Eylül 2020 tarihleri arasında kurumumuzda proksimal üreter taşı nedeniyle SMPCNL, RPUL ve FURS uygulanan hastaların verileri gözden geçirildi. Toplanan veriler yaş, cinsiyet, vücut kitle indeksi (VKİ) ve hidronefroz derecesi, taş yoğunluğu, ameliyat süresi, hastanede kalış ve iyileşme süresi, komplikasyon oranları ve ameliyat süresi gibi taşsız ve demografik verileri içeriyordu.
Bulgular: Genel olarak 162 hasta dahil edildi. Bu hastaların 52’si (%32,1) Grup 1 (SMPCNL grubu), 53’ü (%32,7) Grup 2 (RPUL grubu), 57’si (%35,2) Grup 3’te (FURS grubu) idi. Ortalama ameliyat süreleri Grup 1’de 53±8.2 dakika, Grup 2’de 63,2±6,6 dakika ve Grup 3’te 73,7±7,5 dakika idi (p=0,000). Ortalama hastanede kalış süresi Grup 3’te diğer gruplara göre anlamlı olarak daha kısaydı (p=0.000). İlk değerlendirmede taşsızlık oranları RPUL, SMPCNL ve FURS gruplarında %100, %90.3 ve %87.7 idi. Bu oran FURS grubunda diğer gruplara göre anlamlı derecede düşüktü (p=0.02).
Sonuç: SMPCNL ve RPUL prosedürleri, proksimal üreter taşları 15 mm’den büyük hastaların tedavisinde FURS kadar güvenlidir.

Keywords

supin, perkütan nefrolitotomi, büyük impakte proksimal üreter taşları

References

• 1. Kartal, I., Baylan, B., Çakıcı, M. Çağlar, Sarı, S., Selmi, V., et al (2020). Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones. Archivio Italiano Di Urologia E Andrologia, 92(1), 39-44. https://doi.org/10.4081/aiua.2020.1.39
• 2. Sfoungaristos, S., Mykoniatis, I., Isid, A., Gofrit, O. N., Rosenberg, S., Hidas, G., et al (2016). Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones. BioMed research international, 2016, 6521461. https://doi.org/10.1155/2016/6521461
• 3. Topaloglu, H., Karakoyunlu, N., Sari, S., Ozok, H. U., Sagnak, L., & Ersoy, H. (2014). A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. BioMed research international, 2014, 691946. https://doi.org/10.1155/2014/691946
• 4. Wang, Y., Zhong, B., Yang, X., Wang, G., Hou, P., & Meng, J. (2017). Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC urology, 17(1), 50. https://doi.org/10.1186/s12894-017-0236-0
• 5. Yasui, T., Okada, A., Hamamoto, S., Taguchi, K., Ando, R., Mizuno, K., et al (2013). Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function. SpringerPlus, 2, 600. https://doi.org/10.1186/2193-1801-2-600
• 6. Türk C, Neisius A, Petrik A, Seitz C, Thomas K, Skolarikos A. EAU Guidelines on Urolithiasis (2020). EurAssocUrolGuidel 2020 Ed. 2020; presented.
• 7. Lam, J. S., Greene, T. D., & Gupta, M. (2002). Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. The Journal of urology, 167(5), 1972–1976.
• 8. White, W., & Klein, F. (2006). Five-year clinical experience with the Dornier Delta lithotriptor. Urology, 68(1), 28–32. https://doi.org/10.1016/j.urology.2006.01.031
• 9. Yencilek, F., Sarica, K., Erturhan, S., Yagci, F., & Erbagci, A. (2010). Treatment of ureteral calculi with semirigid ureteroscopy: where should we stop?. Urologia internationalis, 84(3), 260–264. https://doi.org/10.1159/000288225
• 10. Galal, E. M., Anwar, A. Z., El-Bab, T. K., & Abdelhamid, A. M. (2016). Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones. International braz j urol : official journal of the Brazilian Society of Urology, 42(5), 967–972. https://doi.org/10.1590/S1677-5538.IBJU.2015.0644
• 11. Zhang, Y., Yu, C. F., Jin, S. H., Zhu, H., & Na, Y. Q. (2014). A prospective comparative study between minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy in the management of single large stone in the proximal ureter. Urology, 83(5), 999–1002. https://doi.org/10.1016/j.urology.2013.11.034
• 12. Tugcu, V., Resorlu, B., et al (2016). Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience. Urologia internationalis, 96(1), 77–82. https://doi.org/10.1159/000430452
• 13. Scoffone, C. M., Cracco, C. M., et al (2008). Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?. European urology, 54(6), 1393–1403. https://doi.org/10.1016/j.eururo.2008.07.073
• 14. Jones, M. N., Ranasinghe, W., et al (2016). Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital. Investigative and clinical urology, 57(4), 268–273. https://doi.org/10.4111/icu.2016.57.4.268
• 15. McCahy, P., Rzetelski-West, K., & Gleeson, J. (2013). Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous nephrolithotomy. Journal of endourology, 27(6), 705–709. https://doi.org/10.1089/end.2012.0650
• 16. Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery, 240(2), 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae