Safety and efficacy of mini-pcnl as compared to rirs in lower pole calculus 1-1.5cm

Author: 
Suresh D., Chengalvarayan G., Muthulatha N and Illamparuthi C

Aim: To compare the efficacy and safety ofMini-PCNLand RIRS in the management of lower pole renal stones of 1- 1.5 cm.

Materials and methods: Prospective Study was conducted in institute of urology, Madras Medical College, Chennai between the period of January 2016 to September 2016. 50patients were included in this study, 25 in RIRS group& 25 in Mini-PCNL group study group. All patients with single lower pole stone of size 1-1.5 cm with hounsfield unit of >1000 were included. Patient with anatomical abnormality, bleeding diathesis, multiple renal calculus, diverticular stones were excluded. All the eligible patients were enrolled in the study and assigned either to the RIRS group or Mini-PCNL group after getting the informed consent

Results: Six patients (24%) of the RIRS group had sepsis and 2 patients (8% )of the Mini-PCNL group had sepsis.There was significantly higher sepsis rate in the RIRS group,p-value0.0416. 8 patients (32%) of the RIRS group had significant stone fragment,One patient (04%) of the Mini-PCNL group had significant stone fragment,There was statistically significant higher residual calculi rate in the RIRS group. The mean duration of the RIRS procedure was 67.6 minutes.The mean duration of the Mini-PCNL procedure was 57.32 minutes.The procedure duration in the RIRS group was higher than the Mini-PCNL group and the difference was statistically significant,p-value 0.0001.

Conclusion: Complete clearance of lower pole renal calculus of size 1- 1.5 cm, with the lowest morbidity is the goal of the treatment. Mini-PCNL would be the better option for complete clearance of lower pole stone with minimal morbidity and cost effective rather than RIRS .Advantages of Mini-PCNL group includes less operative time, less chances of significant residual stone fragments and low rate of sepsis. More over Mini-PCNL group does not require preoperative stenting. Hence Mini-PCNL would be the better option for lower pole renal calculus of size 1-1.5 cm.

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