Comparison of the efficacy and safety of micro channel percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of upper urinary calculi
Abstract：Objective To analyze and compare the efficacy and safety of micro channel percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) in the treatment of 2.0～3.0 cm upper urinary calculi.Methods From February 2018 to October 2021,72 patients with 2.0～3.0 cm upper urinary calculi diagnosed in our hospital were collected retrospectively and divided into two groups: The MPCNL group was given MPCNL, and the RIRS group was given RIRS treatment, with 36 cases in each group. The patient’s hospitalization related indicators, the stone clearance rate and serum inflammatory indicators at 1 week, 1 month, and 3 months, serum inflammatory markers after surgery [tumor necrosis factor-α(TNF-α), interleukin-10 (IL-10), IL-6, IL-4 and IL-2], visual analogue scale (VAS), renal function (serum creatinine and urea nitrogen),surgery related complications and second-stage surgery were recorded and compared within two groups.Results Compared with the MPCNL group, the intraoperative blood loss, surgery time, hospital stay, creatinine, urea nitrogen in the RIRS group were reduced, and hospitalization expenses were significantly increased (all P<0.05). Compared with the MPCNL group, the stone clearance rate of the RIRS group was lower at 1 week and 1 month after the surgery(χ2=4.126、5.258, all P<0.05).Three days after surgery, compared with the MPCNL group, the TNF-α, IL-6, IL-2 were all increased in the RIRS group, IL-10, IL-4,VAS were all decreased in the RIRS group(all P<0.05).There was no significant difference in complications between two groups(χ2=0.127, P=0.722).Compared with the MPCNL group, the RIRS group had more second-stage surgery(χ2=4.235, P=0.040).Conclusions Both MPCNL and RIRS can be used to treat 2.0～3.0 cm upper urinary calculi. But each has advantages and disadvantages. The cost of MPCNL is lower, but the amount of intraoperative blood loss is higher, and the inflammatory reaction is lower. The postoperative blood loss of RIRS is lower, the inflammatory response is low, but the cost is higher and the probability of second-stage surgery are higher. It is recommended that the treatment plan for upper urinary calculi should be individualized according to the patient's condition and willingness.
