| Purpose To evaluate the efficacy and safety of SMP versus RIRS for the treatment of the lower pole renal calculi measuring 10-20 mm.Methods From October 2015 to March 2017,70 patients with lower pole renal calculi of 10-20 mm Size seen in our clinic who were conducted a randomized controlled trial.Randomly dividing into two groups,35 patients underwent SMP(group SMP)and 35 RIRS(group RIRS).The two groups of patients were compared with regard to operation time,postoperative indwelling catheter situation,drop in hemoglobin level,postoperative pain,complications(modified Clavien classification system),postoperative hospital stay and stone-free rate(3-4 weeks after surgery SFR)and so on.Results Of the 70 randomized patients,65 completed the study,including SMP in 33 and RIRS in 32.The mean operation time for the SMP group was shorter to the RIRS,but the difference was not significant(P > 0.05).The mena hemoglobin drop in the SMP group was higher than the RIRS group,but there was no significant difference;Mean VAS at 4 hours and 12 hours postoperatively in the SMP group was significantly hgher than in the RIRS group.However,no significant difference between the both groups were noted in mean pain VAS at 24 hoours postoperatively.All the patients was no major complications(improved Clavien complication category 3 or higher)in both groups.Mean postoperative hospital stay was longer in the SMP group than in the RIRS group,but there was no statistically significant(P > 0.05).Check the KUB on the first day after surgery,5 patients in the SMP group were found to have residual calculi of the diameter ≤ 4mm,and were implemented external physical vibration lithecbole(EPVL).23 patients in the RIRS group were found to have residual calculi,4 cases of the residual calculi of the diameter ≥ 5mm were implemented ESWL and EPVL,19 cases of the residual calculi of the diameter ≤4mm were implemented EPVL.One month after surgery,check the NCCT of kidney to evaluate the stone-free rate(SFR),97.0%(32/33)in the SMP group and 90.6%(29/32)in the RIRS group,the difference was not statistically significant(P > 0.05).Conclusions(1)RIRS and SMP for lower pole renal calculi of 10-20 mm size are safely and effectively,and have the advantages of fewer complications and faster recovery.If postoperative adjuvant ESWL and EPVL,the effect is much better.(2)SMP is especially suited to some patients with narrow infundibulum or longer lower pole calyx or smaller infundibular-pelvic angle,which restrict RIRS to reach the stone.(3)The treatment effect of the lower pole renal calculi is affected by the anatomical factors,to improve the preoperative examination in detail,to evaluate narrow infundibulum and longe lower pole calyx and steep infundibular-pelvic angle,comprehensive selection for treatments in order to obtain satisfactory results. |
