| Objective To compare the clinical efficacy of Microchannel percutaneous nephrolithotomy and Retrograde intrarenal surgery in the treatment of 1-3cm solitary kidney complicated with renal calculi.Methods We retrospectively analyzed the clinical data of 112 patients with solitary kidney stones who were treated in the Department of Urology of Jiangxi Provincial People’s Hospital from July 2017 to July 2021,79 patients were finally included,of which 39 patients received ureteroscopic lithotripsy(RIRS group)and 40 patients received microchannel percutaneous nephrolithotomy(m PCNL group).All patients were operated successfully.We analyzed general information of these patients(Gender,age,stone diameter,stone location,causes of solitary kidney,degree of hydronephrosis),according to the stone diameter,the stone was divided into 1-2cm group(M1,R1)and 2-3cm group(M2,R2).We compared the coperation time,serum creatinine before and after operation,serum urea nitrogen before and after operation,surgical bleeding volume,hemoglobin before and after operation,total hospitalization expenses,recovery time of gastrointestinal function after operation,postoperative hospital duration,stone removal rate of the first time,total stone removal rate,postoperative complication(Fever,stone street,septic shock,acute renal failure,hemorrhage)and so on data of the two subgroups,and analyzed the data by statistical methods.Results In the general information(Gender,age,stone diameter,stone location,causes of solitary kidney,degree of hydronephrosis),There was no significant difference between all the patients(P >0.05).The results of surgical comparison between the two groups are as follows:,There was no statistically difference in the concentration of serum creatinine,blood urea nitrogen,hemoglobin before and after operation and perioperative serum creatinine in M1,R1 and M2,R2 groups(P >0.05).The postoperative hemoglobin concentration in R1 group decreased less than that in M1 group(9.24±6.50 vs 14.73±17.44),P=0.007<0.05,the difference was statistically significant between the two groups.The postoperative hospital duration,operation time,bleeding volume,total hospitalization expenses and postoperative recovery time of gastrointestinal function in group R1 were less than those in group M1(P =0.00、0.00、0.00、0.028、0.024),P<0.05,the difference was statistically significant between the two groups;The bleeding volume and postoperative hospital duration in group R2 were less than those in group M2,P=0.00,0.001 < 0.05,the difference was statistically significant;The average total cost of hospitalization in group M2 was lower than that in R2(22957.36±4787.90 vs 25058.64±5333.16),but the p value was 0.78 >0.05,the difference was not statistically significant between the two groups.The stone-free rate of the first stage in M1 and M2 groups was higher than that of R1 and R2 groups(93.3%、72.0% vs 76%、57.1%,P=0.162、0.345),P>0.05,the difference was not statistically significant,The total stone-free rate of m PCNL group was similar to that of RIRS group(87.5% vs 84.6%,P=0.466),the difference was not statistically significant(P>0.05);The incidence of postoperative complications in m PCNL group was 4/40(10%),fever occurred in 2 cases,postoperative bleeding in 1 case and septic shock in 1 case,The incidence of postoperative complications in RIRS group was 2/39(5.1%),fever occurred in 1 case and renal colic in the other one.Conclusion For 1-2cm solitary kidney stones,RIRS has advantages in postoperative hospital duration,operation time and bleeding,and there is no significant difference between m PCNL in total stone-free rate,renal function destruction and postoperative complications,thus,which can be used as the prior choice for minimally invasive surgery of solitary kidney stones.For 2-3cm solitary kidney calculi,m PCNL has an advantage in one-stage stone removal rate,but it is not significantly different from RIRS in other aspects.,urologists can choose the mode of operation according to the basic conditions and wishes of patients. |
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