Renal Stones
Conditions
Keywords
PCNL, RIRS, staghorn stone, renal stone
Brief summary
Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for management of large renal calculi larger than 2 cm based on the yearly updated European Association of Urology (EAU) guidelines. However, PCNL is a challenging procedure which may be associated with several complications ranging from mild complications, such as urinary extravasation, leakage, infection and bleeding requiring transfusion to sever complications, such as sepsis, injury to surrounding organs, persistent hematuria and renal function impairment. The overall complication rate varies based on patient factors and surgical expertise. Not only serious complications that defer some endourologists from performing PCNL but also such procedure is contraindicated and avoided by surgeons in cases of retrorenal colon, morbidly obese patients, spinal abnormalities and bleeding diathesis. Therefore, retrograde intrarenal surgery (RIRS) or flexible ureteroscopy (FURS) is increasingly recognized as an effective alternative, particularly for patients seeking a minimally invasive approach with a lower risk of complications. The best practice in dealing with renal stones using FURS can be achieved via preoperative stenting for 2-4 weeks, negative urine culture, ureteral access sheath (UAS) usage and optimizing laser settings. Compared to PCNL, FURS is a less challenging procedure with low learning curve, less invasive and less bleeding. However, the high cost, including laser usage cost, presenting costs and multisession costs, in addition to the high risk of postoperative infection are considered as major drawbacks of FURS. RIRS is emerging as an effective, safe, minimally invasive alternative to PCNL. Yet, the success of RIRS in comparison to PCNL, especially in a single session, is still questionable and there is no consensus about it.
Interventions
PROCEDUREPercutaneous nephrolithotomy
This intervention includes percutaneous nephrolithotomy for lithotripsy of staghorn stone
PROCEDUREFlexible ureteroscopy
This intervention includes Flexible ureteroscopy for lithotripsy of staghorn stone
Sponsors
Menoufia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged ≥18 years. * Diagnosis of complete staghorn renal stones confirmed by non-contrast CT. * Negative urine culture.
Exclusion criteria
* Congenital renal anomalies (e.g., horseshoe kidney, malrotation). * Coagulopathy or uncorrected bleeding disorder. * Pregnancy. * Previous ipsilateral renal surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stone free rate | 1 Month | Stone-free rate (SFR), defined as no clinically significant residual stones on non-contrast 3-mm-cuts CT, measured as yes or no. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operative time | During the surgery | Operative time is defined as time between starting the procedure and termination of it measured in minutes |
| Complications | 1 month | Intra and postoperative complications, defined as complications happens intraoperative and postoperatively, graded by modified clavien-dindo classification |
| Radiation time | During the surgery | Radiation time, defined as time in which ionizing radiation used intraoperatively, measured in minutes |
Countries
Egypt
Contacts
Primary ContactAmmar Alorabi
Outcome results
None listed