To Compare The Efficacy And Safety Of UMP And RIRS In The Treatment Of Lower Calyceal Stones Of 1～2cm And < 1cm

Objective(s):To investigate the efficacy and safety of ultra-mini percutaneous nephrolithotomy(UMP)and flexible ureteroscopic lithotripsy(RIRS)in the treatment of lower calyceal calculi ≤2cm,and to explore the application effect of UMP in patients with lower calyceal calculi(<1cm),to provide new ideas for the treatment of lower calyceal calculi<2cm.Methods:A retrospective analysis was performed on the clinical data of patients with lower calyceal calculi ≤2cm who underwent surgical treatment in the Department of Urology of our hospital from January 2018 to October 2022.A total of 161 patients were included in this study,of which 4 patients with incomplete preoperative data and 3 patients with lost postoperative data were excluded from this study,and a total of 154 patients were included.There were 74 cases in the ultra-mini percutaneous nephrolithotomy(UMP)group and 80 cases in the retrograde flexible ureteroscopic lithotripsy(RIRS)group.The stone size,CT value,hydronephrosis,body mass index,creatinine level,calyceal renal pelvis Angle,calyceal length,calyceal width,and other baseline data of the two groups were statistically analyzed.The operation duration,the changes in hemoglobin and creatinine before and after the operation,VAS score,complications,postoperative hospital stay,stone clearance rate,medical costs,and other related indicators were compared between the two groups.To compare the efficacy and safety of UMP and RIRS in treating lower calyceal calculi ≤2cm,and to explore the application effect of UMP in treating lower calyceal calculi(<1cm).Results:The stone-free rates were 93.2%(69/74)and 97.3%(72/74)in the UMP group and 76.3%(61/80)and 87.5%(70/80)in the RIRS group on the second day and third month after the operation,respectively.The stone-free rate in the UMP group was significantly higher than that in the RIRS group at 2 days and 3 months after operation(P<0.05).The operation time(57.12±15.42min vs 63.62±17.19min)and hospitalization cost(14676.7±1888.0yuan vs16405.7±1548.1yuan)in the UMP group were significantly lower than those in the RIRS group(P<0.05).However,the postoperative pain score,hemoglobin drop value,and postoperative hospital stay in the UMP group were significantly higher than those in the RIRS group(P>0.05),and there was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Comparison of treatment effects in patients with kidney stones<1cm:There was no significant difference in SFR(100%vs 90%)and complication rate(6.7%vs 5%)between UMP and RIRS patients(P>0.05).However,the operation time(40.3±6.2min vs 50.0±10.2min)and hospitalization cost(14681.6yuan vs16586.8yuan)in the UMP group were significantly lower than those in the RIRS group(P<0.05).The two groups had no significant difference in postoperative pain score and postoperative hospital stay(P>0.05).Conclusions:UMP and RIRS have the same value in the treatment of small renal calyceal calculi.For moderate(1～2cm)lower calyceal calculi,both UMP and RIRS are safe.RIRS is superior to UMP in terms of postoperative pain score and postoperative hemoglobin decrease.Compared with RIRS surgery,UMP surgery has certain advantages in single stone clearance rate and hospitalization cost.In the treatment of small renal calyceal calculi(<1cm),there is no significant difference in SFR between the two groups,but the cost of UMP is lower,which has good clinical application value.