Category: Clinical Stones: Outcomes

MP13-6 - Now Is The Time For Individual Surgical Treatment Of Lower Pole Stone: Ethical Dilemma or Scientific Truth

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : To evaluate the safety, efficacy, loss of working day, and cost effectiveness of retrograde intrarenal surgery (RIRS) by flexible ureteroscope and percutaneous nephrolithotomy (PNL) subtypes for the treatment of lower calyceal stones of between 1 and 2 cm.


Methods :

In all, 175 patients with lower calyceal stones between 1-2 cm were randomly divided into five groups (35 patients to each groups): Group A were managed by Standard-PNL, Group B by Mini-PNL, Group C by Ultramini-PNL, Group D by Micro-PNL and Group E RIRS by flexible ureteroscopy. Stone-free was accepted as no rest stone or ≤3 mm clinical insignificance rest stone. If the stone was rest in the first operation, the patient was reevaluated with new condition. Auxiliary procedure was determined in according to new stone location (ureter, renal pelvis, or lower pole), stone size, complication which occurred in the first operation, and expectation of the patients. Auxiliary procedures were semi-rigid ureteroscopy, RIRS, and PNL subtypes. Auxiliary procedures were performed to all patients who have rest stone. Stone-free was achieved in the all patients within three months. Mean age, body-mass index, stone surface area, operation time, fluoroscopy time, hospital stay, return to normal daily life, cost of first procedure (with equipment cost per case), stone free rate, total cost after auxiliary procedure(s) and complication rate compared. First procedure costs were included disposable materials (guide, laser fiber, gloves etc), drugs (antibiotics, fluid replacement, analgesic etc), daily bad price, extra spending (blood transfusion, daily intensive care price etc), double-j stent extraction costs and instrument cost per case. Total costs were included costs of first procedure plus all auxiliary procedure(s) which was performed until stone free was achieved. One-way ANOVA was used for comparing the groups. P value under 0.05 was accepted as significance.


Results : After excluding seven patients (not operated or lost to follow-up) total 168 patients were included final analyze. Mean age of the all patients was 45.4±13 (18-75), BMI 25.1±3 (19-34) and stone surface area 417±132 (157-628). Comparison of the all groups’ outcomes are seen in table. 


Conclusions : Controversy about finding standard treatment of lower pole of kidney stone treatment continues. From RIRS to Standard-PNL, as the invasiveness increases, the hospital stay and duration of return to daily life decreases, but the cost increases. This information should be shared with the patient and it should be ensured that the patient's own socioeconomic status is taken into account.

Abdulmecit Yavuz

Urologist
Antakya State Hospital
Antakya, Hatay, Turkey

Goksel Bayar

Martyr Prof Dr Ilhan Varank Training And Research Hospital
Sancaktepe, Istanbul, Turkey

Muhammet Fatih Kilinc

Urologist
Ankara Training and Research Hospital
Ulucanlar, Ankara, Turkey

Veli MERT.. Yazar

Urologist
Ankara Training and Research Hospital
Ulucanlar, Ankara, Turkey

Sedat Cakmak

Urologist
Karaman Ermenek State Hospital
Ermenek, Karaman, Turkey