Efficacy Analysis Of Retrograde Intrarenal Surgery Combined With Extracorporeal Physical Vibration Lithotripsy And Percutaneous Nephroscopy In The Treatment Of 2-3cm Renal Stones

ObjectiveTo evaluate the safety and efficacy of retrograde intrarenal surgery(RIRS)combined with extracorporeal physical vibration lithecbole(EPVL)and percutaneous nephrolithotripsy(PCNL)in the treatment of 2-3cm renal stones.MethodsThe clinical data of 2-3cm patients with renal stones that hospitalized in the Department of Urology,the Second Affiliated Hospital of Zhengzhou University from October 2018 to October 2020 were retrospectively analyzed.According to the operation method,the data were divided into two groups: RIRS combined with EPVL group,and the PCNL group.The basic information,physical signs,laboratory examination data and imaging examination results were collected and analyzed,then compared the differences between the above-mentiond two groups,including operation time,intraoperative blood loss,renal function,postoperative pain,visual analogue scale(VAS),postoperative complications,stone free rate,stone composition,hospitalization time,etc.ResultsThe clinical data of 145 patients were included,including 94 patients in RIRS combined with EPVL group and 51 patients in PCNL group.There were no statistical differences between the two groups in terms of operation time,changes in renal function,VAS scores,and stone composition(P>0.05).The decrease in hemoglobin and hematocrit in the PCNL group was significantly higher than that in the RIRS combined with EPVL group(P<0.05).In the comparison of the stone free rate,the RIRS combined with EPVL group was significantly lower than that of the PCNL group(21.3% vs.80.4%)in 3 days after surgery,and the comparison between the two groups was statistically significant(P<0.05).In the 4th week after surgery,the stone free rate was 89.4% in the RIRS combined with EPVL group and 90.2% in the PCNL group,and there was no statistical difference(P>0.05).The incidence of postoperative complications was 14.9% in RIRS group and 33.3% in PCNL group(P<0.05).The total incidence of complications in EPVL combined with RIRS increased to 17.0%,but the comparison with PCNL group was still statistical significance(P<0.05).The length of hospital stay in the PCNL group was significantly higher than that in the RIRS combined EPVL group(P<0.05).Conclusion1.The advantages of RIRS combined with EPVL in the treatment of 2-3 cm renal stones are less blood loss during the operation,lower postoperative complication rate and shorter hospital stay.2.The advantages of PCNL for the treatment of 2-3cm renal stones are the high short-term stone free rate,while its disadvantages lie in the large blood loss,higher postoperative complication rate and longer hospital stay.3.In the comparison of the stone free rate between RIRS combined with EPVL and PCNL group in the treatment of 2-3 cm diameter renal stones,the short-term stone free rate(3 days after surgery)by RIRS combined with EPVL treatment was significantly lower than that of PCNL.While after 4 weeks treatment,the stone free rate of the two groups was higher,and there was no significant difference.4.For renal stones with a diameter of 2-3 cm,RIRS combined with EPVL treatment and PCNL treatment have both achieved satisfactory results.Therefore,under adequate preoperative evaluation,RIRS combined with EPVL therapy can be used as another safe and effective treatment for 2-3 cm renal stones.