| Objective:To evaluate the efficacy of Retrograde intrarenal surgery and Minimally invasive percutaneous nephrolithotripsy for the pediatric renal calculi of more than 1.5cm or equal in diameter.Methods:In the retrospective study,from March 2011 to March 2016,99 patients with renal calcuil of more than 1.5cm or equal in diameter underwent operation which is conducted by the same operative team.Among them,42 patients were treated with Retrograde intrarenal surgery(RIRS group),57 patients were treated with Minimally invasive percutaneous nephrolithotripsy(MPCNL group).Comparing the operative completion rate,calculi-free rate,operation time,hemoglobin drop,postoperative complications rate and postoperative hospitalization time between both groups.Results: The mean stone size was 18.85±4.0mm(range 15-30mm)in the RIRS group and 20.67±5.0mm(range 15~35mm)in the MPCNL group.The mean stone size in MPCNL was larger,but the difference was not statistically significant(P=0.08).No statistical significance(P>0.05)was found between the two groups in sex,age,preoperative urinepositive culture,percentage of multiple calculi,and operation history of the same side.But,the urine white blood cells between the two groups were statistically significant(P<0.001).All patients were managed with double J stent placement for 4 weeks before undergoing RIRS.Stones can't be detected in 2 paitients because of the small infundibulopelvic angle and they were ruled out in the subsequent study.The operative completion rate of RIRS group was 95.2%(40/42).The mean operative time was was 90.2 minutes(range 63 ~ 162min).The mean hemoglobin deficit was 7.85 ±7.97g/L.The complication rate was 7.5%(3/40).The mean hospitalization time after operation was 5±2.3 days(range 2~15days).Stone-free rates after one session was 72.5%(29/40),6 cases underwent the second procedure and 3 cases underwent ureteroscopy lithotripsy.With the following up after three months,stone-free rates were up to 90.0%(36/40).The operative success rate of MPCNL group was 100%(57/57).The mean operative time was 77.8±15.6min(range50~135min).The mean hemoglobin deficit was 10.01±7.05g/L.Three suffered from secondary bleeding after MPCNL whose hemoglobin was as little as 65g/L and recovered after undergoing blood transfusion(Clavien ?).Among them,one patient had to undergo superselective renal artery embolization for her uncontrollable bleeding(Clavien ?).The complication rate was 24.6%(14/57).The mean time from operation toleave hospital was 8±2.5days(range 4~19 days).The stone-free rate after one session was 82.5%(47/57),5 cases underwent the second procedure.With the following up after three months,stone-free rates were up to 94.7%(54/57).In statistics,there was no significant difference in operative success rates,hemoglobin drop,the stone-free rate on one session and the final stone-free rates(P>0.05).But significant difference existed in operative operation time,complications rate,postoperative hospitalization time(P<0.05).Conclusion: Both RIRS and MPCNL are feasible,safe and minimally invasive way to treat ?1.5cm renal calculi in pediatric patients.The stone-free rates between the two groups are comparable.RIRS has an advantage in postoperative hospitalization time and postoperative complications.MCNL takes the advantage of operation time and needn't routinely places the Double-J ureteral stent. |
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