Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20-40mm Renal Calculi: A Multicenter Randomized Controlled Trial.
Mini
Percutaneous nephrolithotomy
Randomized controlled trial
Renal stone
Standard
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
04
05
2020
accepted:
10
09
2020
pubmed:
1
10
2020
medline:
28
9
2021
entrez:
30
9
2020
Statut:
ppublish
Résumé
High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. To compare the efficacy and safety of mPNL and sPNL for the treatment of 20-40mm renal stones. A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016-2019). The inclusion criteria were patients 18-70 yr old, with normal renal function, and 20-40mm renal stones. Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (-2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20-40mm renal stones.
Sections du résumé
BACKGROUND
High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking.
OBJECTIVE
To compare the efficacy and safety of mPNL and sPNL for the treatment of 20-40mm renal stones.
DESIGN, SETTING, AND PARTICIPANTS
A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016-2019). The inclusion criteria were patients 18-70 yr old, with normal renal function, and 20-40mm renal stones.
INTERVENTION
Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization.
RESULTS AND LIMITATIONS
The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (-2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used.
CONCLUSIONS
Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization.
PATIENT SUMMARY
We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20-40mm renal stones.
Identifiants
pubmed: 32994063
pii: S0302-2838(20)30718-1
doi: 10.1016/j.eururo.2020.09.026
pii:
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
114-121Commentaires et corrections
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Informations de copyright
Copyright © 2020. Published by Elsevier B.V.