Pd45-10 a multicenter propensity score matched pair study in 313 patients comparing percutaneous nephrolithotomy versus retrograde intra renal surgery for management of urolithiasis in calyceal diverticulum

You have accessJournal of UrologyCME1 Apr 2023PD45-10 A MULTICENTER PROPENSITY SCORE MATCHED PAIR STUDY IN 313 PATIENTS COMPARING PERCUTANEOUS NEPHROLITHOTOMY VERSUS RETROGRADE INTRA RENAL SURGERY FOR MANAGEMENT OF UROLITHIASIS IN CALYCEAL DIVERTICULUM Ee Jean Lim, Danielle Castellani, Olivier Traxer, Deepak Ragoori, Yiloren Tanidir, Bhaskar Kumar Somani, Khi Yung Fong, Mriganka Mani Sinha, Boyke Soebhali, Abhay Mahajan, Pankaj N Maheshwari, Nariman Gadjiev, Saeed Bin Hamri, Yakup Bostanci, Mehmet Ilker Gokce, Cemil Aydin, Innoue Takaki, and Vineet Gauhar Ee Jean LimEe Jean Lim More articles by this author , Danielle CastellaniDanielle Castellani More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Deepak RagooriDeepak Ragoori More articles by this author , Yiloren TanidirYiloren Tanidir More articles by this author , Bhaskar Kumar SomaniBhaskar Kumar Somani More articles by this author , Khi Yung FongKhi Yung Fong More articles by this author , Mriganka Mani SinhaMriganka Mani Sinha More articles by this author , Boyke SoebhaliBoyke Soebhali More articles by this author , Abhay MahajanAbhay Mahajan More articles by this author , Pankaj N MaheshwariPankaj N Maheshwari More articles by this author , Nariman GadjievNariman Gadjiev More articles by this author , Saeed Bin HamriSaeed Bin Hamri More articles by this author , Yakup BostanciYakup Bostanci More articles by this author , Mehmet Ilker GokceMehmet Ilker Gokce More articles by this author , Cemil AydinCemil Aydin More articles by this author , Innoue TakakiInnoue Takaki More articles by this author , and Vineet GauharVineet Gauhar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although calyceal diverticulum is commonly associated with stone formation, the majority of patients tend to be asymptomatic. Choice of management is chiefly based on stone location and mainly encompasses retrograde intrarenal surgery (RIRS) or Percutaneous nephrolithotomy (PCNL). We aimed to assess complications and outcomes of treatment via both approaches. METHODS: Retrospective data of 313 patients from 10 countries were evaluated for patient demographics, peri-operative parameters and outcomes using t-test for continuous normal variables and a Mann–Whitney U test for variables without normal distribution. Categorical data between groups were analysed using the chi-squared test. Propensity score-matching (PSM) was then performed matching for baseline characteristics of age, gender, stone type (single <1cm, single >1cm, or multiple), diverticulum location, and stone size classification.Two subgroup analyses for anomalous (malrotated) kidneys and difficult diverticulum access done. RESULTS: As a cohort, PCNL was the preferred choice for single stones of any size, malrotated kidneys. RIRS was preferred in recurrent stone formers with multiple stones. Access and mode of identification of the opening was similar for both groups. Irrespective of the route of contrast or methylene blue for delineation, guide wire coiling into the divert was equally and successfully utilized by both routes. Post intervention, there was significantly higher residual fragments (RF) (OR 0.12 95% CI 0.03 – 0.36,p<0.001) if no dilatation/widening of diverticulum mouth was performed. 15(8.1%) RIRS cases needed conversion to either PCNL or Endoscopic combined intrarenal surgery (ECIRS) for completion and only 6(4.7%) PCNL cases needed ECIRS.After PSM was applied, significantly more PCNL patients had transient intra-op bleeding but did not require additional surgery. Post operative bleeding, sepsis, perirenal collections and overall stone free rate was similar. On Multivariate analysis, using a Thulium ber laser(TFL) had a higher SFR(OR 3.43 95% CI 1.41 – 9.25, p=0.009) 74 patients had difficult diverticulum access where pain was the main presenting complaint. RIRS was preferred here especially in lower pole and had a signicantly higher SFR(78%, p=0.031). CONCLUSIONS: Our series is the first multicenter study to compare and contrast the utility of the two endourological approaches for renal diverticular urolithiasis. Traditionally, PCNL was the intervention of choice but currently RIRS seems to be equally effective and even preferred when the access particularly in lower pole is difficult. TFL laser complements the surgery and helps improve SFR. A key step is widening of the opening post intervention to minimize residual fragments. Source of Funding: NIL © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1166 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ee Jean Lim More articles by this author Danielle Castellani More articles by this author Olivier Traxer More articles by this author Deepak Ragoori More articles by this author Yiloren Tanidir More articles by this author Bhaskar Kumar Somani More articles by this author Khi Yung Fong More articles by this author Mriganka Mani Sinha More articles by this author Boyke Soebhali More articles by this author Abhay Mahajan More articles by this author Pankaj N Maheshwari More articles by this author Nariman Gadjiev More articles by this author Saeed Bin Hamri More articles by this author Yakup Bostanci More articles by this author Mehmet Ilker Gokce More articles by this author Cemil Aydin More articles by this author Innoue Takaki More articles by this author Vineet Gauhar More articles by this author Expand All Advertisement PDF downloadLoading ...