Comparison Of Retrograde Intrarenal Surgery And Balloon Dilation Tubeless Percutaneous Nephrolithotomy In The Treatment Of 1.5-2cm Kidney Stones

Objective:To compare and contrast the efficacy and safety of retrograde intrarenal surgery with balloon dilation tubeless percutaneous nephrolithotomy in the treatment of kidney stones ranging from 1.5 to 2 cmMethods: The retrospective analysis was performed on patients with 1.5-2cm kidney stones who have received surgeries in Qingdao Municipal Hospital from June 2018 to June 2022.Among these patients,47 patients have received balloon dilation tubeless percutaneous nephrolithotomy and 137 patients have received retrograde intrarenal surgery.We collected the preoperative general data(gender,age,body mass index,renal calculi diameter,renal calculi side and position),perioperative data(operation time,stone free rate(SFR),postoperative hemoglobin decline,visual analogue scale(VAS),hospitalization stay and hospitalization cost)and postoperative complications on each group separately,and then conducted a statistical analysis based on the materials collected to comprehensively compare the surgical efficacy and postoperative complications.Results: There was no statistically significant difference between the two groups in terms of the preoperative general data(P>0.05).In terms of the comparison of perioperative data,there was no statistically significant difference between the two groups in operation time and SFR(P>0.05),however,in the treatment of lower pole calculus,balloon dilation tubeless PCNL was characterized by shorter operation time(92.62 min VS 119.61 min,P<0.05)and higher SFR immediately after operation(100% VS62.5%,P<0.05),though there was no difference in SFR after operation 1 month and 3months.There was no statistically significant difference between the two groups in terms of postoperative hemoglobin volume and postoperative hemoglobin decline(P>0.05).The visual analogous scale(VAS)(2.00 VS 4.00,P<0.05)and the usage of postoperative analgesics(2.9% VS 23.4%,P<0.05)of the patients in the RIRS group were significantly lower than that of the patients in the balloon dilation PCNL group.In terms of hospitalization costs,the balloon dilation tubeless PCNL group was higher than that in the RIRS group(27848.0 yuan VS 17513.0 yuan,P<0.05),and the difference was statistically significant,while in terms of total hospitalization stay,there was no statistically difference between the two groups(P>0.05).As for postoperative complications,there was no statistical difference in terms of the incidence rate of complication of clavien grade Ⅱor above among the two groups(P>0.05);Conclusion: In terms of renal stones ranging from 1.5-2 cm,the RIRS group had less postoperative pain,less usage of postoperative analgesics and less hospitalization costs than balloon dilation tubeless PCNL.The technique of balloon dilation and plasma bipolar electrocoagulation could reduce intraoperative and postoperativethe blood loss of PCNL and thus we needed no placement of nephrostomy tube after surgery.Compared with RIRS,balloon dilation tubeless PCNL did not increase the the incidence of postoperative complication or prolong the time of total hopistalization stay.In addition,balloon dilation tubeless PCNL could treat lower pole stones more effectively,shorten the operation time and improve the SFR immediately after operation.In clinical work,we can choose the best surgical method according to the location of the stone,the technical conditions of the surgeon and the hospital.