Comparison Of Retrograde Intrarenal Surgery And Percutaneous Nephrolithotomy In The Treatment For Lower-pole Stones

Objective To compare the therapeutic effect of retrograde intrarenal surgery(RIRS) and percutaneous nephrolithotripsy(PCNL) in treating patients with lower-pole renal calculi of≤25mm.Methods From Jan.2014 to May.2015, a total of 86 cases treated by either PCNL(50)or RIRS(36) were retrospectively analyzed. Operative time,stone free rate,postoperative hospital stay,hospitalization expenses and complications were compared in the 2 groups.Results The stone burden of the RIRS group and PCNL group was (18.9±3.4)mm and (19.1±3.2)mm, respectively.There was no significant difference in two groups. In RIRS group,operations were performed successfully in all 36 calculi,No serious complications was recorded except postoperative fever in 2 cases. In PCNL group,all patients had been successful operated. Postoperative fever occured in 7 cases.Obvious intraoperative and postoperative haemorrhage appeared in 2 cases, and cured by selective renal artery embolization.The operation time of the RIRS group and PCNL group was (117.9±25. 1)min and (94.0±17. 1)min respectively, and had statistical difference in two groups(P<0.05). The final stone free rate of the RIRS group for≤10mm、 10-20mm、20-25mm was 100%、 92.9%、 81.8%, respectively; The final stone free rate of the PCNL group for≤10mm、10mm-20mm、20mm-25mm was 100%、95.0%、 88.2%, respectively, and had no significant difference in two groups(P>0.05).Hemoglobin decline of the RIRS group and PCNL group was(4.7±1.6)g/l and(16.9±8.9)g/1, and had significant difference in two groups(P<0.05).Postoperative hospital stay of the RIRS group and PCNL group was(6.3±1.4)day and(9.6±2.4)day, and had statistical difference in two groups(P<0.05). Hospitalization expenses of the RIRS group and PCNL group was (16414±2572.6) RMB and(20214±3436.2)RMB, and had statistical difference in two groups(P<0.05).Conclusions Both RIRS and PCNL are feasible, safe way to treat lower-pole renal stones of less than 20mm. RIRS has an advantage in less trauma and complication, lower expenses and fewer hospital stay, and it may be a better choice. PCNL has a slightly higher stone free rate than RIRS in treating lower-pole renal stone during 20mm-25mm, and PCNL have the advantage of fewer operation time. RIRS have the advantages of lower expenses, less trauma and complication. Doctor should consider patient’s condition when they choosing the first-line treatment between PCNL and RIRS.