Presentation Authors: Mohamed Elawdy*, Diaa Eldin Taha, Ahmed A Atwa, Rasha T. Abouelkheir, Ebrahim Elsaeed, Ahmed S El-Hefnawy, Mansoura, Egypt
Introduction: With recent advances in endoscopic procedures, refinement of endoscopic tools, and increased experiences in endourology; complex procedures like ureteroscopy (URS) and percutanous nephrolithotomy (PCNL) can be performed as a simultaneous same-session procedure in appropriately-selected patients. We aimed in our study to estimate the cut-off value or the stone range in which URS and PCNL can be performed on the same session safely in comparison to the staged procedure as a control arm.
Methods: A retrospective analysis between January 2007 and December 2017 that included patients operated on for unilateral simultaneous ureteral and renal stones by URS and PCNL. All had routine laboratory workup. Ultrasonography and abdominal X-ray (KUB) were done as a routine for all patients, in addition to either multislice non-contrast CT or IVU that were used to measure the stone size and burden. Ureteroscopy and PCNL were performed using the standard surgical procedures. The primary outcomes were the immediate stone-free rate and total hospital costs. The second outcomes were the operative and anesthesia times, the complication rate, and hospital stay. The data was collected using SPSS 21Â®
Results: Of 193 patients, 180 were found to have complete files eligible for review. The mean age of the study group was 50+14years, 140 (77%) were male, 79 (50%) were right-sided and 14 (7%) had solitary kidneys. Ninety-five patients had same-session URS and PCNL, as compared to a matched-control group (85 patients) who had staged sessions. Same-stage procedure was the appropriate choice for those who couldnâ€™t tolerate multiple anesthetic settings like elderly patients, and patients with ASA III. Also, this group had a shorter operative time and hospital stay. The same-stage approach helped patients to recover quickly and to return work earlier. It had a similar stone-free rate similar to the staged group. However, surgeons preferred to operate on staghorn and big stones required multiple punctures in a staged-approach. Late complications included three cases of ureteral stricture, two in the staged and one in the same-session group, with new significant backpressure by imaging. Two cases, one in each arm required endoureterotomy.
Conclusions: Same session URS and PCNL (in prone position) can be performed as a same-session procedure in appropriately-selected patients. It can be done with equal results to the staged procedure in renal stones with a median of 18mm (range, 10-30mm) in presence of 7mm or less ureteral stones.