Comparison of the efficacy of three surgical procedures for kidney stones with diameter>2 cm

Abstract:

Objective To compare the safety and efficacy of percutaneous nephrolithotomy，flexible ureteroscope，and intelligent pressure-controlled suction system combined with flexible ureteroscope in the treatment of kidney stones with diameter>2 cm.Methods The clinical data of 90 patients（30 cases per group） with kidney stones with diameter>2 cm treated by percutaneous nephrolithotomy， flexible ureteroscope，and intelligent pressure-controlled suction system combined with flexible ureteroscope from January 2019 to March 2022 in Department of Urology，The First Affiliated Hospital of Chongqing Medical University were collected. The operation time，the intraoperative bleeding volume，the postoperative hospitalization time，the hospitalization cost，the incidence of surgical complications，and the stone clearance rate in 1 month after operation were compared among the three groups.Results The operation time in the percutaneous nephrolithotomy group[（54.1±22.7） min] and the flexible ureteroscope group[（53.9±27.0） min] was shorter than that in the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（81.0±28.2） min] with statistical differences（P<0.05）. The intraoperative bleeding volume in the flexible ureteroscope group[（3.2±2.1） mL] and the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（5.7±4.5） mL] was less than that in the percutaneous nephrolithotomy[（16.1±17.2） mL] with statistical differences（P<0.05）. The postoperative hospitalization time in the flexible ureteroscope group[（1.2±0.5） d] and the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（1.5±1.7） d] was shorter than that in the percutaneous nephrolithotomy group[（6.4±5.2） d] with statistical differences（P<0.05）. The hospitalization cost in the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（2.3±0.4） ten-thousand yuan] was less than that in the flexible ureteroscope group[（2.7±0.4） ten-thousand yuan yuan] with statistical differences（P<0.05）. While there were no statistically differences between the percutaneous nephrolithotomy group[（2.6±0.7） ten-thousand yuan yuan] and the other two groups in terms of the hospitalization cost（P>0.05）. The incidence of fever in the flexible ureteroscope group （33.3%） was higher than that in the percutaneous nephrolithotomy group（10.0%） and the intelligent pressure-controlled suction system combined with flexible ureteroscope group（3.3%） with statistical differences（P<0.05）. The incidence of renal calyx tear bleeding was 3.3%，0.0% in the flexible ureteroscope group，and 0.0% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，without statistical differences（P>0.05）. The incidence of renal pelvis and renal calyx mucosal injury in the intelligent pressure-controlled suction system combined with flexible ureteroscope group（3.3%） was lower than that in the percutaneous nephrolithotomy group（26.7%） and the flexible ureteroscope group（40.0%） with statistical differences（P<0.05）. The incidence of perirenal hematoma was 3.3%，0.0% in the flexible ureteroscope group，and 0.0% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，without statistical differences（P>0.05）. The stone clearance rate in 1 month after operation was 73.3%，20.0% in the flexible ureteroscope group，and 46.7% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，with statistical differences（P<0.05）.Conclusion Percutaneous nephrolithotomy，flexible ureteroscope， and intelligent pressure-controlled suction system combined with flexible ureteroscope are optional in the treatment of kidney stones with diameter>2 cm. Percutaneous nephrolithotomy has the most advantageous in the stone clearance rate，but the incidence of surgical complications is high and the complications are more severe. Intelligent pressure-controlled suction system combined with flexible ureteroscope has higher stone clearance rate than the flexible ureteroscope and lower complications rate. The intelligent pressure-controlled suction system combined with flexible ureteroscope is safe and efficient，so it’s worth promoting the application. The three surgical procedures should be selected according to the actual situations.