陳鵬¹、魏子鈞^1,2、黃逸修^1,2、林子平^1,2、黃子豪^1,2、林登龍^1,2、盧星華^1,2、吳宏豪^1,2、

林志杰^1,2、黃奕燊^1,2、黃志賢^1,2

¹臺北榮民總醫院 泌尿部；

²國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心

Peng Chen¹, Tzu-Chun Wei^1,2, Eric Yi-Hsiu Huang^1,2, Tzu-Ping Lin^1,2, Tzu-Hao Huang^1,2,

Alex T.L. Lin^1,2, Shing-Hwa Lu^1,2, Howard H.H. Wu^1,2, Chih-Chieh Lin^1,2, I-shen Huang^1,2,

William J.S. Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, School of Medicine and Shu-Tien Urological Institute,

National Yang-Ming University, Taipei, Taiwan

The management of urolithiasis in kidney has been drastically changed in the era of endourology. According to EAU guidelines, the management of kidney stones mostly consists of 3 surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Since ESWL is usually in an out-patient and non-invasive way, this study was aimed to examine the stone-free rate (SFR) between PCNL and RIRS.

We retrospectively reviewed medical and operational records. Patients with renal stones treated with either PCNL or RIRS were enrolled from June 2016 to June 2018. Staghorn stones, stones with the diameter < 1cm, or > 2cm were excluded. Patients underwent multiple surgeries because of bilateral renal stones were excluded, as well as those with metabolic disorders, which may lead to bias while calculating SFR. Patients with graft kidney stone were also ruled out. Stone size was calculated by pre-operative image, such as KUB X-Ray, abdominal sonography and/or computed tomography (CT). Follow-up was evaluated by the same image examination within 3 months after surgery. No residual stone or presence of asymptomatic calculi < 4mm were defined as stone-free. Post-operative infection rate was calculated according to medical records, and the operation time was defined as skin to skin interval.

Total 100 patients were enrolled, with 45 PCNL and 55 RIRS. According to exclusion criteria, 39 patients were allocated into each group. Demographic data showed no difference in age, sex, and BMI. However, the average stone size was 1.63cm in PCNL group and 1.40cm in RIRS group, respectively (p=0.009). There was no significant difference in SFR (71.8% vs. 61.5%, p=0.337) but the operation time were significant longer (p<0.001) and the hospital stay was significant shorter (p<0.001) in RIRS group. Post-operative infection rate was also not significantly different between two groups. (8 vs. 7 cases, p=0.774)

PCNL and RIRS are both effective procedures for managing kidney stones. However, the initial stone size might affect the selection of operation by urologists. The stone-free rate was relatively higher in PCNL group but not statistically significant. On the other hand, the operation time was longer, but the hospital stay was shorter in RIRS group. As to the post-operative infection rate, it was nearly identical.