Abstract
Objective To observe the efficacy and safety of single-access minimally invasive percutaneous nephrolithotomy (MPCNL) combined with flexible cystoscopy and multi-access MPCNL in patients with complex renal stones (CRS).
Patients and Methods A total of 195 patients with CRS were prospectively randomized into twogroups. Ninety-eight in the single-access MPCNL group and 97 cases as control in the multi-access MPCNL group. The stone-free rates (SFRs) at different times (Postoperative 2nd day and 4th week end) were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay and operation-related complications.
Results There was no obvious difference between two groups in patients’ demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in single-access MPCNL group than that in multi-access MPCNL group (7.3 vs. 13.4 g/L, P < 0.001). Postoperative hospital stay in single-access MPCNL group was more shorten than that in multi-accessMPCNL group (4.2 vs. 5.1 days, P < 0.001). Moreover, the SFRs of the postoperative 2nd day and 4th week in single-access MPCNL group were both significantly higher than those in multi-access MPCNL group (88.8% vs. 74.2%, P = 0.009; 94.9% vs. 85.6%, P = 0.028, respectively). However, in terms of the rates of low back pain, perirenal hematoma and renal artery embolization, multi-accessMPCNL group were all significantly higher than single-access MPCNL group (18.5 vs. 7.1%, P = 0.017; 13.4 vs. 4.1%, P = 0.021; 4.1 vs. 0.0%, P = 0.042; respectively).
Conclusions Our study shows that single-access MPCNL and flexible cystoscopy are ideal complementary techniques in the treatment of CRS, satisfying both high SFR and minimized renal injury. This method was safe and reproducible in clinical practice.