Comparison of efficacy between mPCNL with holmium laser and EMS standard tract PCNL in the treatment of complex renal calculi under ultrasound guidance

Objective To compare the outcomes of the surgical treatment of complex renal calculi with minimally invasive percutaneous nephrolithotomy(mPCNL) and EMS percutaneous nephrolithotomy(standard tract PCNL) under ultrasound guidance.Methods A total of 78 patients with complex renal calculi were allocated to either mPCNL treatment group(mPCNL group,n=35) or EMS(swiss,the fourth generation) standard tract PCNL treatment group(standard tract PCNL group,n=43).The operative time,primary stone-free rate and operative complications in the two groups were compared.Results 16F and 24F percutaneous renal accesses were successfully established in mPCNL group and standard tract PCNL group respectively,and then the first lithotrity-lithiasis cleaning procedure was performed.The operation time in mPCNL group was longer than that in the standard tract PCNL group 〔(102±31) min vs(67±22) min,P0.05〕.The primary stone-free rate in mPCNL group was lower than that in standard tract PCNL group(65.7% vs 88.4%,P0.05).The postoperative bleeding that needed blood transfusion occurred in one patient of mPCNL group,and no bleeding case that needed blood transfusion occurred in standard tract PCNL group.No injuries of adjacent viscera occurred in all patients.In mPCNL group,pleural effusion occurred in one patient who underwent puncturing upper renal calyce through 11 intercostal place,and cured through closed drainage of pleural cavity.In standard tract PCNL group,abdominis hydrops occurred in two patients who were cured through the treatment of aspirating effusion and diuresis.The body temperature 38.5 ℃ occurred in one case of mPCNL group.There was no significant difference in operative complications in two groups(P0.05).Conclusions Both the treatments of complex renal calculi with mPCNL and EMS(the fourth generation) standard tract PCNL under ultrasound guidance are similarly safe,but the standard tract PCNL has the superiority of higher primary stone-free rate and shorter operation time over the holmium Laser mPCNL.Therefore the standard tract PCNL merits propagation for treating complex renal calculi.