Consultant Urologist Preeti Urology & Kidney Hospital, Hyderabad, india
Introduction: Percutaneous nephrolithotomy (PCNL) has been recommended as the first choice for lower pole stone >10mm. The objective of the study is to analyse whether Retrograde intrarenal surgery (RIRS) with newly upcoming Thulium fiber laser (TFL) can be an equally effective alternative. Primary
Aim: To compare the different treatment modalities in terms of efficacy (stone free rate, need for auxiliary procedures) and safety (complication rate). Secondary aim: To compare the perioperative outcomes (operative time, fluoroscopic time, length of hospitalization). Methods: Study
Design: Prospective randomised controlled study Study period: October 2021 – May 2022 Study Population: Patients with lower pole stones 10-20mm Group A - RIRS, Group B – Mini PCNL The energy source used was 60W TFL (IPG Photonics, Massachusetts, United States) in both Group A and B. NCCT KUB was done at 2 months post operatively to calculate stone free rate. Institutional Ethics Committee approval was obtained. Results: Mean stone size was 13.93 ± 2.92mm in Group A and 15.04 ± 3.18mm in Group B. In Group A, fluoroscopy time was significantly lower (31.96 ± 14.34 vs 337.68 ± 131.85, p<0.001), hospital stay was significantly lower (1.37 ± 0.63 vs 3.24 ± 1.01, p <0.001) and stone free rate (SFR) was comparable to Group B (88.9% vs 92.3%, p=1.000). There was no significant difference in operative time, complication rate or need for auxiliary procedure (Table 1). The ablation speed was significantly higher (9.47 ± 5.61 vs 1.55 ± 1.95, p<0.001), the laser efficacy was significantly lower (3.18 ± 3.83 vs 16.43 ± 7.07, p <0.001) and the laser time was significantly lower (141.04 ± 86.98 vs 992.63 ± 488.30, p <0.001) in Group B, as fragmentation rather than dusting was done with TFL. Table 1 Parameter RIRS with TFL (n=25) MiniPCNL with TFL (n=25) P value Age (years) 44.52 ± 14.21 48.64 ± 12.70 0.5091 Stone Size (mm) 13.93 ± 2.92 15.04 ± 3.18 0.1441 Volume (mm³) 1016.72 ± 341.11 1037.08 ± 428.83 0.4641 Density (HU) 1111.44 ± 252.61 1181.12 ± 288.14 0.3603 Operative Time (Minutes) 48.63 ± 8.57 50.80 ± 15.13 0.4521 Fluoroscopy Time (sec)*** 31.96 ± 14.34 337.68 ± 131.85 <0.0011 Complication rate 4/27 (14.8%) 5/25 (20%) 0.2134 Hospital Stay (Days)*** 1.37 ± 0.63 3.24 ± 1.01 <0.0011 Duration of Follow-Up 7.97 ± 2.47 8.29 ± 2.66 0.6503 Auxiliary Procedure (Yes) 2 (7.4%) 1 (4.0%) 1.0004 Overall Stone free rate 88.9% 92.3% 1.0004 ***Significant at p<0.05, 1: Wilcoxon-Mann-Whitney U Test, 2: Chi-Squared Test, 3: t-test, 4: Fisher's Exact Test Conclusions: RIRS with TFL for lower pole stones has SFR comparable to MiniPCNL, lower fluoroscopy time and hospital stay. No significant difference was found in operative time, complication rate or requirement of auxiliary procedure. Thus, RIRS with TFL is an effective alternative to miniPCNL for lower pole stones 10-20mm SOURCE OF Funding: Self
