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Research article
Kewei Xu
Corresponding Author
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Background：To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods: A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n= 33) or modified UMP (n= 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p< 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p< 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p< 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p< 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p< 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p= 0.504, p= 0.675). There were no significant differences between the two groups in complications (p= 0.228). Conclusion：For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.
Keywords
Lower pole stones, Modified Ultra-mini percutaneous nephrolithotomy, Semi-supine combined lithotomy position, Retrograde intrarenal surgery
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CURRENT STATUS: Published
View the published article at BMC Urology.
Version 5
Posted 13 Feb, 2020
No community comments so far
Editorial decision: Accept
On 14 Feb, 2020
Editor assigned
On 13 Feb, 2020
Submission checks complete
On 12 Feb, 2020
Editor invited
On 12 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 07 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 31 Jan, 2020
Editor assigned
On 20 Jan, 2020
Submission checks complete
On 19 Jan, 2020
Editor invited
On 19 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 14 Jan, 2020
Review #3 received
Received 12 Jan, 2020
Reviewer #3 agreed
On 01 Jan, 2020
Reviewer #2 agreed
On 07 Dec, 2019
Review #2 received
Received 07 Dec, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Review #1 received
Received 19 Nov, 2019
Reviewers invited
Invitations sent on 16 Nov, 2019
Editor assigned
On 29 Oct, 2019
Submission checks complete
On 28 Oct, 2019
Editor invited
On 28 Oct, 2019
No comments provided
Review #1 received
Received 08 Oct, 2019
Editorial decision: Major revision
On 08 Oct, 2019
Review #2 received
Received 06 Oct, 2019
Review #3 received
Received 06 Oct, 2019
Reviewer #3 agreed
On 25 Sep, 2019
Editor assigned
On 23 Sep, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Reviewer #1 agreed
On 23 Sep, 2019
Reviewer #2 agreed
On 23 Sep, 2019
Submission checks complete
On 18 Sep, 2019
Editor invited
On 18 Sep, 2019
First submitted
On 06 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
Urology & Nephrology
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A new preprint design is coming!
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See the published version of this preprint at BMC Urology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Kewei Xu
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Urology.
Version 5
Posted 13 Feb, 2020
No community comments so far
Editorial decision: Accept
On 14 Feb, 2020
Editor assigned
On 13 Feb, 2020
Submission checks complete
On 12 Feb, 2020
Editor invited
On 12 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 07 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 31 Jan, 2020
Editor assigned
On 20 Jan, 2020
Submission checks complete
On 19 Jan, 2020
Editor invited
On 19 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 14 Jan, 2020
Review #3 received
Received 12 Jan, 2020
Reviewer #3 agreed
On 01 Jan, 2020
Reviewer #2 agreed
On 07 Dec, 2019
Review #2 received
Received 07 Dec, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Review #1 received
Received 19 Nov, 2019
Reviewers invited
Invitations sent on 16 Nov, 2019
Editor assigned
On 29 Oct, 2019
Submission checks complete
On 28 Oct, 2019
Editor invited
On 28 Oct, 2019
No comments provided
Review #1 received
Received 08 Oct, 2019
Editorial decision: Major revision
On 08 Oct, 2019
Review #2 received
Received 06 Oct, 2019
Review #3 received
Received 06 Oct, 2019
Reviewer #3 agreed
On 25 Sep, 2019
Editor assigned
On 23 Sep, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Reviewer #1 agreed
On 23 Sep, 2019
Reviewer #2 agreed
On 23 Sep, 2019
Submission checks complete
On 18 Sep, 2019
Editor invited
On 18 Sep, 2019
First submitted
On 06 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Urology.
Background：To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods: A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n= 33) or modified UMP (n= 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p< 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p< 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p< 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p< 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p< 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p= 0.504, p= 0.675). There were no significant differences between the two groups in complications (p= 0.228). Conclusion：For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.
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