Presentation Authors: Ilan Klein*, Rahul Dutta, Marc Colaco, Manish Patel, Jorge Gutierrez-Aceves, Winston Salem, NC
Introduction: Both percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (URS) are options in treating patients with kidney stones that are unlikely to pass without surgical intervention. We sought to compare outcomes and hospital costs for patients randomized to mini-PCNL (mPCNL, tract size 16.5 French) and URS for nephrolithiasis.
Methods: Patients who were candidates for both mPCNL and URS with a kidney stone between 1-2 cm located in the kidney were consented, enrolled, and randomized to a treatment group. Post-operative stone burden was assessed with low-dose CT scan between day 1 and 30 post-operatively. Hospital costs for operating room time, anesthesia time, and equipment (including equipment repairs) for the procedure were obtained.
Results: A total of 49 patients were randomized to either mPCNL or URS. There were no significant differences between patient demographics (age, body mass index, ASA score) or pre-operative variables (pre-operative creatinine, prior stent placement, stone size, stone Hounsfield units). Fluoroscopy time was significantly higher in mPCNL procedures. There was no difference in intra-op complication rate or pre to post-operative creatinine change. Residual stone burden was lower in mPCNL, though this was not statistically significant (p = 0.1523). Although operating room time was higher for mPCNL, this did not reach statistical significance. There was no difference in total hospital costs for each procedure between the two groups; however, equipment cost was significantly higher in URS procedures ($617.55 vs $1,076.08, p < 0.0001).
Conclusions: In this prospective randomized study, we found no difference in the efficacy of mPCNL or URS for 1-2 cm kidney stones in terms of stone free rate or requirement of a second procedure. In terms of cost, the increased cost of equipment for URS appears to be balanced by the higher operating room time required for mPCNL. Both procedures are reasonable options for patients who require operative management of 1-2 cm nephrolithiasis.