Pd18-06 Randomised Controlled Trial of Ultra Mini Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery in the Treatment of 10-30mm Calculi
Year: 2016
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2016PD18-06 RANDOMISED CONTROLLED TRIAL OF ULTRA MINI PERCUTANEOUS NEPHROLITHOTOMY VERSUS RETROGRADE INTRARENAL SURGERY IN THE TREATMENT OF 10-30MM CALCULI Soumendra Datta, Ka-Wing Ng, Ronak Solanki, and Janak Desai Soumendra DattaSoumendra Datta More articles by this author , Ka-Wing NgKa-Wing Ng More articles by this author , Ronak SolankiRonak Solanki More articles by this author , and Janak DesaiJanak Desai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently it has been shown prospectively, that Ultra Mini PCNL (UMP) is safe and effective in treating renal 1-3 cm calculi without the necessary need for nephrostomy or stent. The current standard of care for this group of patients is usually Retrograde Intra-Renal Surgery (RIRS) or standard PCNL. The objective of this study was to compare UMP and RIRS in a Randomised Controlled Trial (RCT). METHODS This is a prospective RCT of UMP and RIRS with an allocation ratio of 2:1 in favour of UMP performed by a single surgeon. Ethical committee approval was obtained and all patients provided informed consent. Effectiveness was assessed by stone-free rates, operative time, Clavien complication rate, length of stay, cost of consumables and analgesic requirements. Inclusion criteria were 1-3cm stones with no history of bleeding diathesis and screened for infection. RESULTS Between 2014-15, 150 patients were randomised to UMP (101) or RIRS (48) with one patient withdrawing consent. The mean stone size for those patients who had UMP was 16.3mm, and 16.0 mm for RIRS. Mean operating time was 41 minutes (UMP) compared to 74 minutes (RIRS) (p<0.0001). No patient who had UMP required a second procedure compared to RIRS, which had 47 patients (97.9%) who required stent removal under flexible cystoscopy. The number of patients that required a double J stent in UMP was 1 (0.99%) and in RIRS was 48 (100%). Nephrostomy was required in 22 (21.8%) of the UMP patients, and none of the RIRS patients. Mean nephrostomy dwell time was 17 hours. Mean stent removal was at 1 week. Mean change in haemoglobin and creatinine in UMP was -0.46g/dl and 0.10 mg/dl and with RIRS -0.31g/dl and 0.12mg/dl respectively. Mean length of stay was 39.21 hours (UMP) and 39.08 hours (RIRS). Stone free rate intraoperatively and at 1 month in the UMP group (99% and 100%) and the RIRS group was 2% and 71% (p<0.001). Stone free was defined as absence of calcification on CT KUB.11 UMP and 6 RIRS patients did not attend for 1 month CT scan. The Clavien-Dindo complication rate was 10% (UMP) and 33% (RIRS) (p=0.0009) with all being grades 1-2. Mean consumable costs in UMP were US$ 46 and in RIRS US$423 (p<0.0001). CONCLUSIONS Ultra mini PCNL has a superior stone free rate and fewer complications compared to RIRS in this prospective randomised study in the treatment of 1-3cm stones. There is no routine need for stenting. The cost of consumables is almost one tenth of RIRS with a comparable length of stay. Further multi-centre studies are required but UMP should be considered strongly as a first line treatment alongside RIRS. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e405-e406 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Soumendra Datta More articles by this author Ka-Wing Ng More articles by this author Ronak Solanki More articles by this author Janak Desai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2320055321