title: The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis.
abstract: OBJECTIVE
  To compare the treatment outcomes between retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MPCNL) for the management of stones larger than 2 cm in patients with solitary kidney.
  
  
  METHODS
  Between December 2012 and March 2014, 53 patients with a solitary kidney suffering from urinary stones larger than 2 cm were treated with RIRS. The outcomes of these patients were compared to a cohort of similar solitary kidney stone patients who underwent MPCNL using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: size, number and location of stones, age, BMI, gender and previous ipsilateral open surgery.
  
  
  RESULTS
  A stone-free rate (SFR) of 43.4 % was achieved after a single procedure in patients treated with RIRS and a SFR of 71.70 % in patients treated with MPCNL (p = 0.003). The operative time for RIRS was longer (p = 0.002), but the median hospital stay was shorter (p < 0.001). Average drop in hemoglobin level was comparable in both groups (9.30 vs. 10.85 g/L, p = 0.35). The transfusion rate as well as the incidence of postoperative complications such as fever and urosepsis was not statistically different between these two groups. Major complications (Clavien score 3a-4a) occurred in 3.77 and 1.89 %, RIRS and MPCNL, respectively (p = 1.000).
  
  
  CONCLUSIONS
  Patients with a solitary kidney suffering from stones larger than 2 cm in size who undergo MPCNL had a higher SFR than RIRS. The complications were comparable in both groups. Even though RIRS patients spent less time in hospital, this procedure might not be an effective treatment as MPCNL in solitary kidneys with larger and multiple stones.
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China, gzgyzgh@vip.tom.com.
authors.forename: Guohua
authors.initials: G
authors.lastname: Zeng
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Jiasheng
authors.initials: J
authors.lastname: Li
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Zhao
authors.forename: Tao
authors.initials: T
authors.lastname: Zeng
authors.forename: Chenli
authors.initials: C
authors.lastname: Liu
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Yuan
authors.forename: Shaw P
authors.initials: SP
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D000013:Congenital Abnormalities; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D007674:Kidney Diseases / Q000150:complications / Q000151:congenital*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods