To comparatively evaluate clinical outcomes of super-mini percutaneous nephrolithotomy (SMP) and Miniperc for treating urinary tract calculi larger than 2 cm.
An international multi-center, retrospective cohort study was conducted at 20 tertiary care hospitals across five countries (China, the Philippines, Qatar, UK, and Kuwait) between April 2016 and May 2019. SMP and Miniperc were performed in 3525 patients with renal calculi diameter larger than 2 cm. The primary endpoint was the stone-free rate (SFR). The secondary outcome objective was blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, tubeless rate, and hospital stay. Propensity score matching (PSM) analysis was used to balance the selection bias between the two groups.
2012 and 1513 patients underwent SMP and Miniperc, respectively. After matching, 1380 patients from each group were included for further analysis. Overall, no significant difference was found in mean operation time and SFRs between two groups. However, hospital stay and postoperative pain were significantly in favor of SMP (p<0.001 and p<0.001, respectively). Tubeless rate was significantly higher in the SMP group (72.6% vs 57.8%, p <0.0001). Postoperative fever was much more common in the Miniperc group (12.0% vs 8.4%, p=0.002). When the patients were further classified into 3 subgroups based on stones diameters (2-3, 3-4, and >4cm). The advantages of SMP was most obvious in 2-3 cm stones and eliminated as the size of the stone increased, with longer operation time in the latter two subgroups. Compared with Miniperc, the SFRs of SMP was comparable in 3-4 cm stones but lower SFR in >4cm stones. There was no statistical difference in blood transfusion and renal embolization between the two groups.
Our data showed that SMP is an ideal treatment option for stones less than 4 cm stones and is more efficacious for 2-3 cm stones, with lower postoperative fever, less blood loss, and pain compared to Miniperc. SMP was less efficiency for > 4 cm stones with prolonged operative time.
BJU international. 2020 Apr 11 [Epub ahead of print]
Yang Liu, Chao Cai, Zihao Xu, Albert Aquino, Shabir Al-Mousawi, Xuepei Zhang, Simon K S Choong, Xiang He, Xianming Fan, Bin Chen, Jianhua Feng, Xuhui Zhu, Tarek Ibrahim, Houping Mao, Huilong Tang, Dayong Jin, Xiancheng Li, Fenghong Cao, Hua Jiang, Yongfu Long, Wei Zhang, Gang Wang, Xin Zhang, Shanfeng Yin, Guohua Zeng
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China., Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines., Division of Urology, Al-Amiri Hospital, SABAH ALAHMAD Urology Center, Ministry of Health, Kuwait City, Kuwait., Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China., Institute of Urology, University College London Hospitals, London, UK., Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical college, Hangzhou, China., Department of Urology, The Third Affiliated Hospital of Xiamen, The Third Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Xiamen, China., Department of Urology, The Affiliated Hospital of Xiamen University, Xiamen, China., Department of Urology, Longgang District Central Hospital, Shenzhen, China., Department of Urology, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China., Department of Urology, Hamad Medical Corporation, Doha, Qatar., Department of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China., Department of Urology, The First Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China., Department of Urology, Liaoyuan City Central Hospital, Liaoyuan, China., Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China., Department of Urology, North China University of Science and Technology Affiliated Hospital, Tangshan, China., Department of Urology, Zhongda Hospital Southeast Hospital, Nanjing, China., Department of Urology, Central Hospital of Shaoyang, Shaoyang, China., Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China., Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.