S051: Comparison of flexible ureterorenoscopy and mini percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm

S051: Comparison of flexible ureterorenoscopy and mini percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm Akbulut F., Kucuktopcu O., Kandemir E., Sonmezay E., Simsek A., Ozgor F., Binbay M., Muslumanoglu A.Y., Gurbuz G. Haseki Training and Research Hospital, Dept. of Urology, Istanbul, Turkey INTRODUCTION & OBJECTIVES: The aim of this study was to compare the outcomes of flexible ureterorenoscopy and mini percutaneous nephrolithotomy in the treatment of lower calyceal stones smaller than 2 cm. MATERIAL & METHODS: Patients who underwent flexible ureterorenoscopy (F-URS) and mini percutaneous nephrolithotomy (miniPNL) for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and February 2014 were retrospectively evaluated. Each group included 20 patients. All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. RESULTS: Success rates for F-URS and miniPNL were 80% and 85%, respectively. Operation time, fluoroscopy time and hospitalisation time for F-URS and miniPNL patients were 63.10 minutes, 2.4 minutes, 28.3 hours and 105.16 minutes, 7.05 minutes, and 76.8 hours, respectively. All three parameters were significantly shorter among the F-URS group (p<0.001). Peroperative haemoglobin drop did not differ significantly (p=0.618). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p=0.019). More patients in the F-URS groups developed fever that required antibiotics, and more patients in the miniPNL group required ureteral double J (DJ) catheter insertion under general anaesthesia. Table 1: Preoperative patient demographics

Number Gender Male Female Age (years) BMI (Kg/M2) Stone area (mm2) Opacity Opaque Non-opaque Hydronephrosis 0 1 2 3 4 Side of surgery

F-URS 20

miniPNL 20

All Patients 40

P Value 0.311

12 15 27 8 5 13 45.75±12.98 39.84±17.815 42.87±15.60 0.242 28±8.19 27.22±4.27 27.90±6.48 0.317 191.65±52.50 202.75±97.50 197.20±77.50 0.657 0.292 17 19 36 3 1 4 0.149 7 2 7 13 2 3 3 1 0 1 0.022

Left 9 Right 11 History of renal stone surgery Primary 14 Secondary 6

16 4

25 15 0.507

12 8

26 14

BMI: Body mass index Table 2: Comparison of surgical results between the operation groups F-URS

miniPNL

P Value

Operation time (min) 63.10±27.12 105.16±38.25 <0.001 Fluoroscopy time (min) 2.4±1.39 7.05±4.26 <0.001 Hospitalisation time (hours) 28.30±33.67 76.80±29.75 <0.001 Haemoglobin drop (mg/dl) 0.38±0.97 0.15±1.78 0.618 Stone fragmentation device 0.07 No fragmentation 0 1 Laser 20 14 Laser pneumatic 0 1 Ultrasonic 0 4 Clavien score 1 2 3A 3B 4 5 Result CIRF Residual stone Stone-free

0.019 0 4 0 1 0 0

2 0 0 6 0 0 0.11

7 4 9

2 3 15

CIRF: Clinically insignificant residual fragments CONCLUSIONS: Although both F-URS and miniPNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favourable due to shorter fluoroscopy, operation and hospitalization times. Eur Urol Suppl 2014; 13(7) e1445