PCNL vs RIRS in management of stones in calyceal diverticulum : outcomes from a global multicentre match paired study that reflects real world practice. / Gauhar, Vineet; Traxer, Olivier; Woo, Shauna Jia Qian; Fong, Khi Yung; Ragoori, Deepak; Wani, Amish; Soebhali, Boyke; Mahajan, Abhay; Pankaj, Maheshwari; Gadzhiev, Nariman; Tanidir, Yiloren; Mehmet, İlker Gokce; Aydin, Cemil; Bostanci, Yakup; Bin Hamri, Saeed; Barayan, Fahad R; Sinha, Mriganka Mani; Inoue, Takaaki; Teoh, Jeremy Yuen-Chun; Castellani, Daniele; Somani, Bhaskar K; Lim, Ee Jean.
In: World Journal of Urology, Vol. 41, No. 11, 11.2023, p. 2897-2904.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - PCNL vs RIRS in management of stones in calyceal diverticulum
T2 - outcomes from a global multicentre match paired study that reflects real world practice
AU - Gauhar, Vineet
AU - Traxer, Olivier
AU - Woo, Shauna Jia Qian
AU - Fong, Khi Yung
AU - Ragoori, Deepak
AU - Wani, Amish
AU - Soebhali, Boyke
AU - Mahajan, Abhay
AU - Pankaj, Maheshwari
AU - Gadzhiev, Nariman
AU - Tanidir, Yiloren
AU - Mehmet, İlker Gokce
AU - Aydin, Cemil
AU - Bostanci, Yakup
AU - Bin Hamri, Saeed
AU - Barayan, Fahad R
AU - Sinha, Mriganka Mani
AU - Inoue, Takaaki
AU - Teoh, Jeremy Yuen-Chun
AU - Castellani, Daniele
AU - Somani, Bhaskar K
AU - Lim, Ee Jean
N1 - © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/11
Y1 - 2023/11
N2 - INTRODUCTION: Calyceal diverticulum (CD) is the outpouching of a calyx into the renal parenchyma, connected by an infundibulum. Often associated with recurrent stones, common surgical options include percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS). We aim to present the real-world practises and outcomes comparing both approaches and the technical choices made.MATERIALS AND METHODS: Retrospective data including 313 patients from 11 countries were evaluated. One hundred and twenty-seven underwent mini-PCNL and one hundred and eighty-six underwent RIRS. Patient demographics, perioperative parameters, and outcomes were analysed using either T test or Mann-Whitney U test. Categorical data between groups were analysed using the Chi-squared test. Propensity score matching (PSM) was performed matching for baseline characteristics. Subgroup analyses for anomalous/malrotated kidneys and difficult diverticulum access were performed.RESULTS: After PSM, 123 patients in each arm were included, with similar outcomes for stone-free rate (SFR) and complications (p < 0.001). Hospitalisation was significantly longer in PCNL. Re-intervention rate for residual fragments (any fragment > 4 mm) was similar. RIRS was the preferred re-intervention for both groups. Intraoperative bleeding was significantly higher in PCNL (p < 0.032) but none required transfusion. Two patients with malrotated anatomy in RIRS group required transfusion. Lower pole presented most difficult access for both groups, and SFR was significantly higher in difficult CD accessed by RIRS (p < 0.031). Laser infundibulotomy was preferred for improving diverticular access in both. Fulguration post-intervention was not practised.CONCLUSION: The crux lies in identification of the opening and safe access. Urologists may consider a step-up personalised approach with a view of endoscopic combined approach where required.
AB - INTRODUCTION: Calyceal diverticulum (CD) is the outpouching of a calyx into the renal parenchyma, connected by an infundibulum. Often associated with recurrent stones, common surgical options include percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS). We aim to present the real-world practises and outcomes comparing both approaches and the technical choices made.MATERIALS AND METHODS: Retrospective data including 313 patients from 11 countries were evaluated. One hundred and twenty-seven underwent mini-PCNL and one hundred and eighty-six underwent RIRS. Patient demographics, perioperative parameters, and outcomes were analysed using either T test or Mann-Whitney U test. Categorical data between groups were analysed using the Chi-squared test. Propensity score matching (PSM) was performed matching for baseline characteristics. Subgroup analyses for anomalous/malrotated kidneys and difficult diverticulum access were performed.RESULTS: After PSM, 123 patients in each arm were included, with similar outcomes for stone-free rate (SFR) and complications (p < 0.001). Hospitalisation was significantly longer in PCNL. Re-intervention rate for residual fragments (any fragment > 4 mm) was similar. RIRS was the preferred re-intervention for both groups. Intraoperative bleeding was significantly higher in PCNL (p < 0.032) but none required transfusion. Two patients with malrotated anatomy in RIRS group required transfusion. Lower pole presented most difficult access for both groups, and SFR was significantly higher in difficult CD accessed by RIRS (p < 0.031). Laser infundibulotomy was preferred for improving diverticular access in both. Fulguration post-intervention was not practised.CONCLUSION: The crux lies in identification of the opening and safe access. Urologists may consider a step-up personalised approach with a view of endoscopic combined approach where required.
KW - Humans
KW - Nephrolithotomy, Percutaneous
KW - Kidney Calculi/surgery
KW - Nephrostomy, Percutaneous
KW - Retrospective Studies
KW - Treatment Outcome
KW - Cysts
U2 - https://doi.org/10.1007/s00345-023-04650-2
DO - https://doi.org/10.1007/s00345-023-04650-2
M3 - Article
C2 - 37864647
VL - 41
SP - 2897
EP - 2904
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 11
ER -
ID: 116243471