Purpose: To compare vacuum-assisted percutaneous nephrolithotomy (VAmini-PCNL) with retrograde intra-renal surgery (RIRS) for the treatment of renal stones measuring 2-3 cm in diameter. Material and methods: This retrospective study included children receiving treatment for pyelocalyceal stones of 2-3 cm in diameter from November 2018 to September 2022. Consecutive patients undergoing VAmini-PCNL after 2020 were compared with a historically matched group undergoing RIRS. VAminiPCNL was performed using a 12-Ch nephroscope through a 16-Ch vacuum ClearPetra access sheet. RIRS was performed using a flexible ureteroscope through a ureteral sheath. The endpoints included the need for pre-stenting, duration of surgery, complications, stone-free rate (SFR), and need for secondary procedures. Results: The patients were grouped into two with 15 patients for each group. VAmini-PCNL group was not different from the RIRS one for age at surgery [median (range) 6.6 (1-12)years vs. 7.7 (1.5-14)years], and stone diameter [median (range) 2.4 (2.0-2.9)cm vs. 2.3 (2.1-2.8)cm] and density [median (range) 577.5 (421-1068) vs. 541.5 (462-927) Hunsfield Units]. Pre-stenting was necessary in five RIRS patients (33 %). The median duration of surgery was 85.3 (76-112)min for VAmini-PCNL vs. 150.6 (132-167)min for RIRS, p = 0.00001. No major complications were observed. The SFR was 100 % after VAmini-PCNL and 60 % after RIRS, p = 0.02. All residual fragments were removed with a second RIRS. Conclusion: VAmini-PCNL was feasible and safe in children aged >1 year. It allowed for a significantly higher SFR despite a significantly shorter operative time than RIRS, which also requires pre-stenting in one-third of patients and a second RIRS in 40 % of cases. Level of Evidence: III.

Collura, G., D'Ippolito, G., Lopes Mandes, A.l., Innocenzi, M., Del Prete, L., Mele, E., et al. (2024). Vacuum-assisted Mini-percutaneous Nephrolithotomy for 2–3-cm Renal Stones: A Comparative Study with Retrograde Intra-renal Surgery. JOURNAL OF PEDIATRIC SURGERY, 59(3), 412-415 [10.1016/j.jpedsurg.2023.10.051].

Vacuum-assisted Mini-percutaneous Nephrolithotomy for 2–3-cm Renal Stones: A Comparative Study with Retrograde Intra-renal Surgery

D'Ippolito G.;Innocenzi M.;Castagnetti M.
2024-01-01

Abstract

Purpose: To compare vacuum-assisted percutaneous nephrolithotomy (VAmini-PCNL) with retrograde intra-renal surgery (RIRS) for the treatment of renal stones measuring 2-3 cm in diameter. Material and methods: This retrospective study included children receiving treatment for pyelocalyceal stones of 2-3 cm in diameter from November 2018 to September 2022. Consecutive patients undergoing VAmini-PCNL after 2020 were compared with a historically matched group undergoing RIRS. VAminiPCNL was performed using a 12-Ch nephroscope through a 16-Ch vacuum ClearPetra access sheet. RIRS was performed using a flexible ureteroscope through a ureteral sheath. The endpoints included the need for pre-stenting, duration of surgery, complications, stone-free rate (SFR), and need for secondary procedures. Results: The patients were grouped into two with 15 patients for each group. VAmini-PCNL group was not different from the RIRS one for age at surgery [median (range) 6.6 (1-12)years vs. 7.7 (1.5-14)years], and stone diameter [median (range) 2.4 (2.0-2.9)cm vs. 2.3 (2.1-2.8)cm] and density [median (range) 577.5 (421-1068) vs. 541.5 (462-927) Hunsfield Units]. Pre-stenting was necessary in five RIRS patients (33 %). The median duration of surgery was 85.3 (76-112)min for VAmini-PCNL vs. 150.6 (132-167)min for RIRS, p = 0.00001. No major complications were observed. The SFR was 100 % after VAmini-PCNL and 60 % after RIRS, p = 0.02. All residual fragments were removed with a second RIRS. Conclusion: VAmini-PCNL was feasible and safe in children aged >1 year. It allowed for a significantly higher SFR despite a significantly shorter operative time than RIRS, which also requires pre-stenting in one-third of patients and a second RIRS in 40 % of cases. Level of Evidence: III.
2024
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MEDS-14/B - Chirurgia pediatrica e infantile
English
Pediatric urolithiasis
Kidney calculi
Percutaneous nephrolithotomy
Vacuum suction
Retrograde intra-renal surgery
Collura, G., D'Ippolito, G., Lopes Mandes, A.l., Innocenzi, M., Del Prete, L., Mele, E., et al. (2024). Vacuum-assisted Mini-percutaneous Nephrolithotomy for 2–3-cm Renal Stones: A Comparative Study with Retrograde Intra-renal Surgery. JOURNAL OF PEDIATRIC SURGERY, 59(3), 412-415 [10.1016/j.jpedsurg.2023.10.051].
Collura, G; D'Ippolito, G; Lopes Mandes, Al; Innocenzi, M; Del Prete, L; Mele, E; Barneschi, Ac; Castagnetti, M
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/415969
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