Comparison Of PCNL And RIRS In The Treatment Of Renal Stones Complicated With Renal Cysts

Objective The incidence and recurrence rate of kidney stones are on the rise around world.Kidney stones cause kidney damage through two different mechanisms: urinary tract obstruction and urinary tract infections.Renal cysts are also common benign tumors in the clinic.There are many types of renal cysts,mostly congenital,a few are acquired and undetermined,but most renal cysts progress slowly.Percutaneous nephrolithotomy(PCNL)and Retrograde intrarenal surgery(RIRS)are common surgical method for the treatment of kidney stones.It is noted that some patients have renal cysts in our clinical treatment,which make difficulty to clinical treatment.The purpose of this study is to compare the effects of PCNL and RIRS on renal stones with renal cysts and the effect of renal cysts on surgery and prognosis.Methods Review the clinical data of kidney stones complicated with renal cysts patients undergoing PCNL or RIRS surgery at the Second Hospital of Tianjin Medical University from 2016 to 2018,including:gender,age,cyst location,cyst diameter,stone location,stone diameter,operative time,stone clearing rate,length of hospital stay and so on.CT or KUB was reviewed one month after surgery.The standard of clear stone was no obvious stone residue or residual stone diameter ? 4mm and no clinical symptoms.Statistical methods were used for the analysis.Results The total sample size of the study was 226 patients,and the PCNL group was compared with the RIRS group(Table 1): age(P=0.692),gender(P=0.593),lateral(P=0.722),cyst position(P=0.945),Cyst size(P=0.354),stone position(P=0.968),clear stone rate(P=0.14)were not statistically significant,stone diameter(P=0.026),operation time(P=0.029),hospital stay(P< 0.01),the incidence of complications(P<0.01)was statistically significant.Whether the cyst in the PCNL group impeded the optimal puncture path(Table 2)and the operation time(P=0.021)and complication rate(P=0.08)were statistically significant.The rate of clear stone was significantlyaffected by cyst size(P=0.003)and stone size(P=0.048)in the PCNL group(Table 3),but not in the RIRS group(Table 4).Conclusions1.In the treatment of kidney stones with renal cysts,both RIRS and PCNL have higher rates of clear stone,but RIRS has shorter operation time,postoperative hospital stay,and lower complication rate.2.When PCNL is used to treat kidney stones with renal cysts,the operation time and the incidence of complications will be affected by the location and diameter of the cyst.3.The rate of clear stone was significantly affected by cyst position and size and stone size in PCNL surgery,but not in RIRS group.In the choice of surgical treatment for kidney stones complicated with renal cysts,we should not only consider the size and location of the stones and the patient's own conditions,but also the location of the cysts and stones(the choice of the puncture path)and its size.