Tubeless-mini-PCNL Versus RIRS For Renal And Upper Ureter Stones Of 2-2.5cm: A Prospective Controlled Study

ObjectiveTo explore the clinical efficacy of Tubeless mini-percutaneous nephrolithotomy(TMPCN)versus retrograde intrarenal surgery(RIRS)for renal and upper ureter stones of 2-2.5 cm.MethodsFrom Sep 2015 to Sep 2017,50 and 46 patients with renal and upper ureter stones of 2-2.5 cm were taken TMPCN and RIRS respectively,we analyzed and compared their basic information,operation time,postoperative hospitalization time,blood loss,stone free rate,postoperative complications and total cost of hospitalization.ResultsThe operative time was 35-110(mean 63.5±16.9)min and 45-150(mean 78.2±20.6)min in TMPCN and RIRS group respectively(P<0.05).Hemoglobin loss was 0.1-12(Median ± interquartile range=1.0±1.5)g/L and 0.1-2.7(Median ± interquartile range= 0.4±0.8)g/L in TMPCN and RIRS group respectively(P<0.05).Stone free rate was 96.0%(48/50)in TMPCN group and 78.0%(36/46)in RIRS group,(p<0.05).Total cost of hospitalization was 29186-42144(mean 34580±3143)yuan and 23168-36624(mean 28157±2885)yuan in TMPCN and RIRS group respective(P<0.05).Postoperative hospitalization time was 2-8(Median ± interquartile range=2.0±1.0)d and 2-8(Median ± interquartile range=2.0±0.0)d in TMPCN and RIRS group respectively(P>0.05).Postoperative complications were 4.0%(2/50)and 4.3%(2/46)in TMPCN and RIRS group respectively(P>0.05).ConclusionsBoth TMPCN and RIRS were effective and safe treatment for renal and upper ureter stones of 2-2.5 cm.TMPCN has better stone free rate and shorter operation time than RIRS,but postoperative hospitalization time and postoperative complications did not increase.The disadvantages of TMPCN were higher blood loss,more total cost of hospitalization and more difficulties of surgery.TMPCN is a safer and better method with higher stone free rate and shorter operation time,but considering surgery operation difficulty and trauma,TMPCN could not replace RIRS completely by now.