Med Bull Sisli Etfal Hosp. Accepted Articles: SETB-49225 | DOI: 10.14744/SEMB.2024.49225

In the Treatment of Lower Pole Kidney Stones Between 1-2 cm in Children, Which is the Best Approach? Retrograde Intrarenal Surgery or Mini Percutaneous Nephrolithotomy

Yusuf Arikan¹, Enes Dumanli¹, Yusuf Alper Kara², Ali Kumcu³, Mehmet Zeynel Keskin¹, Ulas Can Erdogan^1
1Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Türkiye
²Department of Pediatric Surgery, Izmir Bayrakli City Hospital, Izmir, Türkiye
³Department of Urology, Tekirdag Dr. Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Türkiye

Objective: Kidney stones are treated with many methods, but there is no consensus on which method should be preferred for 1-2 cm lower renal stones. In our study, we aimed to investigate the results of mini (Percutaneous Nephrolitotomy) PCNL and (Retrograde Intrarenal Surgery) RIRS in lower renal pole 1-2 cm stones.
Material-Methods: Twenty-four Mini PCNL and 55 RIRS patients were included in the study. Demographic data of the patients and information about stones on Non-Computed Tomography (NCCT) were recorded. Stone free status (SFR), need for additional treatment and complications of both methods were compared.
Results: Operative time was 55.2±20.8 min in Mini PCNL and 70.7±36.5 min in RIRS, which was statistically significantly lower (p=0.002). Length of hospital stay was 2.4 ± 1.5 days in the Mini PCNL and 1.3 ± 0.7 days in the RIRS, which was statistically significantly longer (p=0.011). In the postoperative 1st month and 3rd month stone-free rates (SFR) was higher in the mini PCNL group. While the 1st month SFR was 91.6% and 54.5%, the 3rd month stone-free rates were 95.8% vs 69.1%, respectively (p<0.001). The need for re-treatment was statistically lower in the mini PCNL group (p<0.001). In terms of complications, the incidence of complications was 16.6% (pain in 2 patients, fever in 1 patients, need for blood transfusion in 1 patient) in the mini PCNL group and 21.8% (pain in 2 patients, fever in 8 patients, sepsis in 2 patients) in the RIRS group. There was a significant difference between the two groups (p=0.008).
Conclusion: Mini PCNL have a higher SFR, less need for re-treatment and fewer complications.

Keywords: Flexible ureterorenoscopy, kidney stone, mini PCNL, retrograde intrarenal surgery

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Çocuklarda 1-2 cm Alt Pol Böbrek Taþlarýnýn Tedavisinde En Ýyi Yaklaþým Hangisidir? Mini Perkütan Nefrolitotomi veya Retrograd Ýntrarenal Cerrahi

Yusuf Arikan¹, Enes Dumanli¹, Yusuf Alper Kara², Ali Kumcu³, Mehmet Zeynel Keskin¹, Ulas Can Erdogan^1
1Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Ýzmir
²Ýzmir Bayraklý Þehir Hastanesi, Çocuk Cerrahisi Kliniði, Ýzmir
³Tekirdað Dr. Ýsmail Fehmi Cumalýoðlu Þehir Hastanesi, Üroloji Kliniði, Tekirdað

Amaç: Böbrek taþlarý birçok yöntemle tedavi edilmektedir, ancak 1-2 cm alt böbrek taþlarýnda hangi yöntemin tercih edilmesi gerektiði konusunda fikir birliði yoktur. Çalýþmamýzda alt renal pol 1-2 cm taþlarýnda mini (Perkütan Nefrolitotomi) PCNL ve (Retrogarad Ýntrarenal Cerrahi) RIRS sonuçlarýný araþtýrmayý amaçladýk.
Materyal-Metod: Yirmi dört Mini PCNL ve 55 RIRS hastasý çalýþmaya dahil edildi. Hastalarýn demografik verileri ve Non-Kontrast Bilgisayarlý Tomografi (NCCT)'deki taþ bilgileri kaydedildi. Her iki yöntemin taþsýzlýk durumu (SFR), ek tedavi ihtiyacý ve komplikasyonlarý karþýlaþtýrýldý.
Bulgular: Ameliyat süresi Mini PCNL'de 55.2±20.8 dk iken RIRS'de 70.7±36.5 dk idi ve istatistiksel olarak anlamlý derecede daha düþüktü (p=0.002). Hastanede kalýþ süresi Mini PCNL'de 2.4 ± 1.5 gün ve RIRS'de 1.3 ± 0.7 gün olup istatistiksel olarak anlamlý derecede uzundu (p=0.011). Ameliyat sonrasý 1. ay ve 3. ay taþsýzlýk oranlarýnda SFR mini PCNL grubunda daha yüksekti. Birinci ay SFR sýrasýyla %91,6 ve %54,5 iken, üçüncü ay taþsýzlýk oranlarý %95,8 ve %69,1 idi (p<0,001). Yeniden tedavi ihtiyacý mini PCNL grubunda istatistiksel olarak daha düþüktü (p<0.001). Komplikasyonlar açýsýndan, komplikasyon insidansý mini PCNL grubunda %16,6 (2 hastada aðrý, 1 hastada ateþ, 1 hastada kan transfüzyonu ihtiyacý) ve RIRS grubunda %21,8 (2 hastada aðrý, 8 hastada ateþ, 2 hastada sepsis) idi. Ýki grup arasýnda anlamlý bir fark vardý (p=0.008).
Sonuç: Mini PCNL daha yüksek SFR'ye, daha az yeniden tedavi ihtiyacýna ve daha az komplikasyona sahiptir. (SETB-2024-04-070)

Anahtar Kelimeler: Fleksibl üreterorenoskopi, böbrek taþý, mini PCNL, retrograd intrarenal cerrahi

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