RIRS vs Mini PCNL for Surgical Treatment of Renal Stone
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1 RIRS vs Mini PCNL for Surgical Treatment of Renal Stone Jean de la Rosette
2 Trends in Stone management No of Publications PCNL ESWL URS Year
3 Trends in Stone management
4 Which treatment is best?
5 RIRS vs Mini PCNL Indications Outcomes Complications Limitations Future perspective
6 Indications
7 > 20 mm 1. PNL 2. URS or SWL mm SWL or URS or PNL < 10 mm 1. SWL or URS 2. PNL < 10 mm 1. SWL 2. URS > 10 mm URS or SWL < 10 mm 1. URS or SWL > 10 mm 1. URS 2. SWL
8 Outcomes
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15 URS outcome
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20 URS outcome 2868 patients 1678 (59%) single stone Flexible URS 1211 patients Upper Calyx 12 % Middle Calyx 13 % Lower Calyx 47 % Renal Pelvis 28 % Stone size < 10 mm 52% mm 43% > 20 mm 5%
21 URS outcome Parameter < 10 mm mm > 20 mm P value Stone free Number Operation time Mean (SD) Hospital Stay Mean (SD) 545 (91%) (n=602) 378 (77%) (n=492) 16 (31%) (n=51) P< (32) 77 (42) 111 (49) P< (2.3) 1.5 (2.5) 2.1 (3.2) NS
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24 Complications
25 D D e e p p a a r r t t m e e n n t t o o f f U U r r o o l o l o g g y, y, A A c c a a d d e e m i c i c M M e e d d i c i c a a l l C C e e n n t t e e r r A A m s s t t e e r r d d a a m
26 D D e e p p a a r r t t m e e n n t t o o f f U U r r o o l o l o g g y, y, A A c c a a d d e e m i c i c M M e e d d i c i c a a l l C C e e n n t t e e r r A A m s s t t e e r r d d a a m
27 Operating Times and Bleeding Complications in Percutaneous Nephrolithotomy: A comparison of Tract Dilation Methods in 5537 Patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study Akito Yamaguchi,Andreas Skolarikos, Niels-Peter Buchholz, Gonzalo Bueno Chomon, Michael Grasso, Pietro Saba, Stephen Nakada and Jean J.M.C.H de la Rosette, on behalf of the CROES PCNL study group
28 Operating Times and Bleeding Complications in Percutaneous Nephrolithotomy: A comparison of Tract Dilation Methods in 5537 Patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study Akito Yamaguchi,Andreas Skolarikos, Niels-Peter Buchholz, Gonzalo Bueno Chomon, Michael Grasso, Pietro Saba, Stephen Nakada and Jean J.M.C.H de la Rosette, on behalf of the CROES PCNL study group
29 Tear begins from 15 Fr
30 28Fr Amplatz and 11.0 Fr UMP sheath
31 URS complications
32 URF-V Olympus DUR-D ACMI- Olympus COBRA Wolf Polyscope VIPER Wolf DUR-D ACMI- Olympus URF-P5 Olympus Flex- X2 Storz Distal Tip : 5.4 to 9 F Proximal Tip : 8.4 to 10.9 F
33 URS complications Complication < 10 mm mm > 20 mm P value Bleeding 2 (0.3% 6 (1.2%) 0 (0.0%) NS Fever 12 (2.0%) 18 (3.5%) 4 (7.4%) P<0.05 Sepsis 2 (0.3%) 6 (1.2%) 1 (1.9%) NS UTI 4 (0.7%) 9 (1.8%) 2 (3.7%) NS Other 14 (2.3%) 14 (2.8%) 1 (1.9%) NS
34 Limitation
35 Limitation URS EAU Guidelines 2013
36 Which patients are NOT candidates for URS?
37 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
38 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
39 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
40 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
41 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
42 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
43 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
44 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
45 NOT good candidates Young boys Prior UPJ surgery Ureteral stricture Recurrent NMIBC Staghorn stones Calyceal diverticulum Horseshoe Kidney Urinary Diversion Radiation retroperitoneum
46 Limitation PNL EAU Guidelines 2013
47 NOT good candidates Morbid obese Multiple PCNL Pelvic Kidney Body deformities Coagulopathy
48 NOT good candidates Morbid obese Multiple PCNL Pelvic Kidney Body deformities Coagulopathy
49 NOT good candidates Morbid obese Multiple PCNL Pelvic Kidney Body deformities Coagulopathy
50 NOT good candidates Morbid obese Multiple PCNL Pelvic Kidney Body deformities Coagulopathy
51 NOT good candidates Morbid obese Multiple PCNL Pelvic Kidney Body deformities Coagulopathy
52 Future perspective
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56 Future perspective Available Equipment Stone Localization Co-morbidity Stone size Patient Age Anatomy Patient Preference Coagulopathy
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