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Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis

Lee SW, Chaiyakunapruk N, Chong HY, Liong ML

BJU Int, 2015 Aug;116(2):252-64.

PMID: 25381743 DOI: 10.1111/bju.12983

To compare the effectiveness of various treatments used for lower pole renal calculi.

Matched MeSH terms: Kidney Calculi/surgery*

Fulltext Percutaneous renal surgery for urolithiasis

Tan HM, Cheung HS

Med J Malaysia, 1990 Jun;45(2):118-22.

PMID: 2152015

Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.

Matched MeSH terms: Kidney Calculi/surgery*

Comparison of the Efficacy and Safety of Laparoendoscopic Single-Site Surgery with Conventional Laparoscopic Surgery for Upper Ureter or Renal Pelvis Stones in a Single Institution: A Randomized Controlled Study

Park J, Lee SB, Cho SY, Jeong CW, Son H, Park YH, et al.

Urol J, 2016 Aug 25;13(4):2759-64.

PMID: 27576882

PURPOSE: To evaluate the utility and safety of laparoendoscopic single-site surgery (LESS) in comparison with conventional laparoscopic (CL) surgery for the treatment of upper urinary tract stones.

MATERIAL AND METHODS: Between June 2011 and May 2012, 20 patients with upper urinary tract stones were included in this prospective randomized study. The patients were assigned into the LESS group or CL group in a one-on-one manner using a random table. The clinical parameters were evaluated in the immediate postoperative period, and the stone clearance rate was evaluated via non-contrast computer tomography at one month postoperatively.

RESULTS: There were no significant differences in patient demographics or preoperative stone sizes between the two groups. The perioperative parameters, including operative time, estimated blood loss, postoperative pain scores, length of hospital stay, and changes in renal function, were comparable. No transfusions or open conversions were required in either group. The incidence of residual stones was lower in the LESS group (1 case) than in the CL group (2 cases). However, this difference was not statistically significant.

CONCLUSIONS: For large and impacted upper ureteral stones, the effectiveness and safety of LESS were equivalent to those of CL. Further randomized control trials with larger sample sizes are needed to strengthen the conclusions of this study.&nbsp.

Matched MeSH terms: Kidney Calculi/surgery*

Bilateral renal calculi

Sreenevasan G

Ann R Coll Surg Engl, 1974 Jul;55(1):3-12.

PMID: 4845653

Bilateral renal calculi were present in 114 (10.7%) of 1,070 cases of proved urinary calculus admitted to the Urological Department of the General Hospital, Kuala Lumpur, during the period November 1968-May 1973. The management of bilateral renal calculi is discussed with reference to the first 100 cases in this series. The introduction of renography has greatly facilitated the decision as to which kidney should be operated on first. The management of patients with and without uraemia is discussed and the use of the modified V and V-Y incisions for the removal of staghorn calculi is described. Complications and results are briefly reviewed.

Matched MeSH terms: Kidney Calculi/surgery*

Fulltext Retrograde intrarenal surgery for renal stones smaller than 2 cm

Ho CC, Hafidzul J, Praveen S, Goh EH, Bong JJ, Lee BC, et al.

Singapore Med J, 2010 Jun;51(6):512-5.

PMID: 20658113

Extracorporeal shock wave lithotripsy (ESWL) is accepted as the gold standard treatment for renal stones that are smaller than 2 cm. Recently, retrograde intrarenal surgery (RIRS) has been introduced as another form of treatment. We report our experience in dealing with renal stones smaller than 2 cm using RIRS as the primary treatment and following failed ESWL.

Matched MeSH terms: Kidney Calculi/surgery*

Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

Kwok JL, Somani B, Sarica K, Yuen SKK, Zawadzki M, Castellani D, et al.

Urolithiasis, 2024 Nov 15;52(1):162.

PMID: 39545972 DOI: 10.1007/s00240-024-01662-4

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm3, p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.

Matched MeSH terms: Kidney Calculi/surgery

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