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 -