Comparison Of The Clinical Application Of UMP And RIRS About Renal/Upper Ureteral Calculi

BackgroundUrlithiasis is common in urology.In the surgical treatment of urinary calculi,various minimally invasive surgical methods have been emerging in recent years.However,with the emergence of new surgical methods,due to the lack of understanding of the new operation,lack of grasp of indications and surgical points,complications also continue to emerge,and even serious adverse events such as nephrectomy and death.Therefore,how to grasp the characteristics of the new surgical method,and give full play to its advantages,has become an important goal of our exploration.A comparative study is made on the application of hyperfine percutaneous nephroscopy and retrograde ureteroscopy in renal /upper ureteral calculi within 2.0 cm diameter,so as to offer guidance for the selection of clinical operation methods.ObjectiveTo compare the efficacy and safety of ultra mini percutaneous nephrolithotomy(UMP)and retrograde ureteroscopic lithotripsy(RIRS)in renal / ureteral calculi within 2.0 cm diameter.Methods1.From December 2017 to May 2020,the surgical treatment of renal / upper ureteral calculi within 2.0 cm diameter completed by the same team was analyzed retrospectively.All surgical protocols were known before operation,voluntary choice of surgical treatment and signature of informed consent.2.Due to the different surgical methods,the subjects were divided into two groups:ultra mini percutaneous nephrolithotomy(UMP)and retrograde ureteroscopic lithotripsy(RIRS).Preoperative routine color ultrasound,X line,CT and various laboratory tests to determine the surgical indications,surgical treatment.The operation time,blood loss and intraoperative injuries were observed.Postoperative attention to observe the patient’s recovery,to understand whether there are bleeding and infection and other complications.The renal CT was reviewed for stone clearance rate.3.The changes of preoperative age,sex,stone size,location,hydronephrosis,body mass index,creatinine level,intraoperative operative time,bleeding volume,intraoperative side injury,renal pelvis pressure,and postoperative bleeding,infection,VAS score,complication rate,stone clearance rate,postoperative hospitalization days,medical expenses,and stone recurrence were analyzed and compared between the two groups.The advantages and disadvantages of UMP、RIRS two surgical methods were discussed.Results1.There were 113 cases in this study,including 46 cases of ultra mini percutaneous nephrolithotomy(UMP group)and 67 cases of retrograde ureteroscopic lithotripsy(RIRS group).There was no meaning distinction in baseline data between the two groups,which was comparable.2.Preoperative indicators of the two study groups are as follows: The operative time of the two groups was 65.8±17.1 in the UMP group and 63.7±16.2 in the RIRS group(P>0.05).The amount of bleeding in UMP group was 43.5±11.7ml,which was significantly higher than that in RIRS group(6.2 ± 0.8ml,P < 0.05).9 cases(19.57%)of intraoperative side injury in UMP group were more than 4 cases(5.98%)in RIRS group(P< 0.05).The intrarenal pressure during operation in the UMP group was 10.7±1.6 mm Hg significantly lower than 23.8 ±5.7mm Hg in the RIRS group(P<0.05).3.The indexes of the two groups were as follows after the operation:Postoperative hospitalization days(4.1±0.6 days)of UMP group were longer than RIRS group(2.1±0.4days,P<0.05).The incidence of secondary hemorrhage in UMP group(5 cases,10.87%)was higher than that in RIRS group(0 case,0.00%,P < 0.05);and the hemoglobin decreased 0.8g、1.3g in 2 patients with renal pelvis perforation after operation,which improved after bed rest and enhanced hemostasis treatment.The incidence of postoperative infection in RIRS group(11 cases,16.42%)was higher than that in UMP group(1case,2.17%,P < 0.05),and the hemogram was increased in 5 cases,of which 3 cases had fever and body temperature up to 39.0℃,and then after strengthening the anti-infection recovery.On the same day after operation,the inflammatory indexes such as leukocyte,C-reactive protein and arsenite in RIRS group were higher than those in UMP group,RIRS group was more likely to be complicated with infection(P < 0.05).The stone clearance rate of UMP group was 87.0% and 93.5%,which was higher than that of RIRS group(70.1%,79.1%,P<0.05)of CT inspection on day 2 and 2 months after operation.The levels of serum creatinine and hydronephrosis were improved in both groups,and the improvement was more obvious in UMP group(P<0.05).The VAS score of UMP group(5.16 ± 1.25)was much higher than that of RIRS group(2.97 ± 1.03,P < 0.05).The hospitalization expenses in the UMP group(14392.3±2194.8 yuan)were lower than those in the RIRS group(16278.7±2497.5 yuan,P<0.05).4.Follow-up 6 months to 3 years after discharge.UMP group recurred 0 cases(0.00%),RIRS group recurred 8 cases(11.94%).Median recurrence time 1.6 years,six patients were treated with ESWL once and two patients were treated with ESWL twice.5.There were no transfusion cases,no conversion to open surgery,no nephrectomy and no death cases.ConclusionUMP and RIRS are effective surgical treatments for renal / ureteral calculi within 2.0cm diameter.But the two methods have their own advantages and disadvantages:UMP advantage lies in high stone clearance and better recovery of renal function,but the risk of injury and bleeding is also high.The RIRS is carried out along the natural passage of human body,its advantages are minimal trauma,less bleeding and quick recovery,but low stone clearance rate and high risk of infection are its important shortcomings.