الفهرس 
KIDNEY STONESOnly 14 pages are availabe for public view
 |  | from | 168 |  |  |
| | | from | 168 | | |
Abstract
C
urrent guidelines recommend percutaneous nephrolithotomy (PCNL) as first-line therapy for large kidney stones.
Technical refinements and technology incorporation to PCNL such as ultrasound-guided percutaneous access, miniaturized tract size, flexible instruments and endoscopic combined intrarenal surgery (ECIRS) increased stone free rate (SFR) and decreased complications.
RIRS is an appealing choice of treatment for residual stone fragments as it can be used to treat multiple fragments simultaneously and inspect the entire renal collecting system.
Retrograde intrarenal surgery (RIRS) is increasingly used as a primary modality to treat post PCNL residual calculi with higher success rate (SR) but with disadvantages of invasiveness and anesthesia.
The main results of the study revealed that:
There no significant difference between the groups regarding age, gender, BMI, and residence.
There no significant difference between the groups regarding comorbidities.
There no significant difference between the groups regarding ASA.
There no significant difference between the groups regarding previous PCNL Guy’s classification, and percutaneous tracts.
There no significant difference between the groups regarding stone density, size, volume and stone number.
There a significant difference between the groups regarding inferior calyx located stone.
There no significant difference between the groups regarding stone composition.
there a significant difference between the groups regarding postoperative hospital stay.
No significant difference between the two groups regarding stone free rate. Thus, 0 mm stones were significantly more frequent in RIRS group compared to SWL group. Meanwhile, >2 mm stones were significantly more frequent in SWL group compared to RIRS group
The major complication was fever in both groups. However, no significant difference was found between the two groups regarding postoperative complications.
CONCLUSION
F
rom the findings of this study, we can conclude that RIRS has better SFR for the treatment of RSFs after standard PCNL. RIRS has better SFRs, higher minor complications, and lower major complications than SWL for the treatment of RSFs after standard PCNL. Our study proved that, residual stones after PCNL are better managed by RIRS than SWL. SFR and success rate were lower in patients treated by SWL than RIRS. Struvite stones that should be completely cleared should not be selected for SWL treatment. Two patients from the SWL group visited ER in pain owing to Steinstrasse and needed re-hospitalization for ureteroscopy. Three patients of RIRS group came to ER with urinary tract infection, lumbar pain, and urinary infection plus lumbar pain, one each. All patients were treated and dismissed without hospitalization. It would be important to validate our results with other population with a randomized clinical trial.
RECOMMENDATIONS
Further studies with larger sample size are needed to confirm the current results.
Further multicenter studies are needed to confirm the current results.
We recommend using retrograde intra renal surgery after standard PCNL for follow up for improvement of kidney stones.
We recommend the combination between retrograde intra renal surgery and other diagnostic methods for better accuracy