Introduction
Material and methods
Outcomes
Data collection, definitions, and setting
Study population and selection
Data collection
Outcomes and follow-up
Statistical analysis
Results
Patient and procedure characteristics
Characteristics | All procedures n = 666 | LSD-URS n = 95 (14.3) | RSP-URS n = 571 (85.7) |
p value | Test |
---|---|---|---|---|---|
Age, median in years [IQR] | 53, [40–65] | 53, [39–61] | 53, [40–65] | 0.56 | C |
(n = 666) | (n = 95) | (n = 571) | |||
Gender | |||||
Male, n (%) | 423 (63.5) | 57 (60.0) | 366 (64.1) | 0.44 | A |
Female, n (%) | 243 (36.5) | 38 (40.0) | 205 (35.9) | ||
(n = 666) | (n = 95) | (n = 571) | |||
BMI median [IQR] | 26.0, [23.8–9.0] | 25.9, [24.2–29.6] | 26.0, [23.7–29.0] | 0.57 | C |
(n = 652) | (n = 91) | (n = 561) | |||
ASA score, n (%) | |||||
I | 242 (36.3) | 37 (38.9) | 205 (35.9) | 0.85 | A |
II | 336 (50.5) | 45 (47.4) | 291 (51.0) | ||
III | 86 (12.9) | 13 (13.7) | 73 (12.8) | ||
IV | 2 (0.3) | 0 (0) | 2 (0.4) | ||
(n = 666) | (n = 95) | (n = 571) | |||
Comorbidity and medication, n (%) | |||||
DM | 90 (13.5) | 16 (17.8) | 74 (13.0) | 0.31 | A |
(n = 665) | (n = 95) | (n = 570) | |||
CVD | 245 (36.8) | 30 (31.6) | 215 (37.7) | 0.25 | A |
(n = 665) | (n = 95) | (n = 570) | |||
Crohn’s disease | 20 (3.0) | 0 (0) | 20 (3.4) | 0.096 | B |
(n = 665) | (n = 95) | (n = 570) | |||
Prednisone | 30 (4.5) | 4 (4.2) | 26 (4.6) | 1.0 | B |
(n = 665) | (n = 95) | (n = 570) | |||
Anticoagulation | 117 (17.6) | 11 (9.4) | 106 (18.6) | 0.096 | A |
(n = 665) | (n = 95) | (n = 570) | |||
Previous stone treatment in the same renal unit, n (%) | |||||
URS | 253 (38.0) | 43 (45.3) | 210 (36.8) | 0.12 | A |
(n = 666) | (n = 95) | (n = 571) | |||
PCNL | 87 (13.1) | 20 (21.1) | 67 (11.7) | 0.013 | A |
(n = 666) | (n = 95) | (n = 686) | |||
SWL | 123 (15.9) | 20 (19.6) | 82 (14.4) | 0.087 | A |
(n = 663) | (n = 95) | (n = 569) | |||
Ureterolithotomy | 6 (0.9) | 0 (0) | 6 (1.1) | 0.60 | B |
(n = 666) | (n = 95) | (n = 571) | |||
Pyelolithomy | 8 (1.2) | 4 (4.2) | 4 (0.7) | 0.017 | B |
(n = 665) | (n = 95) | (n = 570) | |||
Anatomical variant | |||||
Anomalies | 37 (5.6) | 11 (11.6) | 26 (4.6) | 0.006 | A |
(n = 666) | (n = 95) | (n = 571) | |||
Solitary kidney | 16 (2.4) | 2 (2.1) | 14 (2.5) | 1.00 | B |
(n = 666) | (n = 95) | (n = 571) |
Characteristics | All procedures n = 182 | LSD percutaneous n = 56 (30.8) | RSP percutaneous n = 126 (69.2) |
p value | Test |
---|---|---|---|---|---|
Age, median in years [IQR] | 51, [36–66] | 53.5, [38–67] | 51, [34–65] | 0.30 | C |
(n = 182) | (n = 56) | (n = 126) | |||
Gender | |||||
Male, n (%) | 107 (58.8) | 29 (51.8) | 78 (61.9) | 0.20 | A |
Female, n (%) | 75 (41.2) | 27 (48.2) | 48 (38.1) | ||
(n = 182) | (n = 56) | (n = 126) | |||
BMI, median [IQR] | 25.6, [22.8–28.2] | 25.1, [22.4–27.9] | 25.6, [23.1–28.4] | 0.43 | C |
(n = 179) | (n = 56) | (n = 123) | |||
ASA score, n (%) | |||||
I | 55 (30.2) | 19 (33.9) | 36 (28.6) | 0.39 | A |
II | 101 (55.5) | 27 (48.2) | 74 (58.7) | ||
III | 26 (14.3) | 10 (17.9) | 16 (12.7) | ||
IV | 0 (0) | 0 (0) | 0 (0) | ||
(n = 182) | (n = 56) | (n = 126) | |||
Comorbidity and medication, n (%) | |||||
DM | 18 (9.9) | 5 (8.9) | 13 (10.3) | 1.00 | B |
(n = 182) | (n = 56) | (n = 126) | |||
CVD | 79 (43.4) | 23 (41.4) | 56 (44.4) | 0.67 | A |
(n = 126) | (n = 56) | (n = 126) | |||
Crohn’s disease | 3 (1.6) | 0 (0) | 3 (2.4) | 0.55 | B |
(n = 126) | (n = 56) | (n = 126) | |||
Prednisone | 14 (7.7) | 2 (3.6) | 12 (9.5) | 0.23 | B |
(n = 126) | (n = 56) | (n = 126) | |||
Anticoagulation | 29 (15.9) | 11 (19.6) | 18 (14.3) | 0.36 | A |
(n = 128) | (n = 56) | (n = 126) | |||
Previous stone treatment, n (%) | 107 (58.8) | 32 (57.1) | 75 (59.5) | 0.76 | A |
In the same renal unit | (n = 182) | (n = 56) | (n = 126) | ||
SWL | 37 (20.3) | 12 (21.4) | 25 (19.8) | 0.81 | A |
(n = 182) | (n = 56) | (n = 126) | |||
URS | 33 (18.1) | 12 (21.4) | 21 (16.7) | 0.44 | A |
(n = 182) | (n = 56) | (n = 126) | |||
PCNL | 55 (30.2) | 13 (23.2) | 42 (33.3) | 0.17 | A |
(n = 182) | (n = 56) | (n = 126) | |||
ECIRS | 24 (13.2) | 10 (17.9) | 14 (11.1) | 0.24 | B |
(n = 182) | (n = 56) | (n = 126) | |||
Pyelolithomy | 9 (4.9) | 3 (5.4) | 6 (4.8) | 1.00 | B |
(n = 182) | (n = 56) | (n = 126) | |||
Anatomical variant | |||||
Renal anomalies, n (%) | 9 (4.9) | 4 (7.1) | 5 (4.0) | 0.46 | B |
(n = 182) | (n = 56) | (n = 126) | |||
Solitary kidney, n (%) | 5 (2.7) | 2 (3.6) | 3 (2.4) | 0.64 | B |
(n = 182) | (n = 56) | (n = 126) |
Outcomes | LSD-URS n = 95 (14.3) | RSP-URS n = 571 (85.7) |
p value | Test |
---|---|---|---|---|
Total stone burden (mm2) median,[IQR] | 91, [44–192] | 48, [25–87] | 0.001 | C |
(n = 95) | (n = 558) | |||
General stone location | ||||
Kidney | 80 (84.2) | 284 (49.7) | 0.001 | A |
Ureter | 11 (11.6) | 235 (41.2) | ||
Kidney and ureter | 4 (4.2) | 52 (9.1) | ||
(n = 95) | (n = 571) | |||
Kidney stone location, n (%) | ||||
Renal pelvis | 12 (15.0) | 48 (16.9) | 0.93 | A |
Upper calix | 5 (6.3) | 17 (6.0) | ||
Middle calix | 8 (10.0) | 26 (9.2) | ||
Lower calix | 26 (32.5) | 103 (36.3) | ||
Multiple | 29 (36.3) | 90 (31.7) | ||
(n = 80) | (n = 284) | |||
Ureteral location, n (%) | ||||
Proximal | 3 (27.3) | 83 (35.3) | 0.25 | A |
Mid | 2 (18.2) | 45 (19.1) | ||
Distal | 5 (45.5) | 104 (44.3) | ||
Multiple | 1 (9.1) | 3 (1.3) | ||
(n = 11) | (n = 235) | |||
Pre-operative ureteral stent, n (%) | 28 (29.5) | 174 (30.5) | 0.84 | A |
(n = 95) | (n = 571) | |||
Exit strategy | ||||
Double J stent | 52 (54.7) | 283 (49.6) | 0.19 | A |
Ureteral catheter | 27 (28.4) | 156 (27.3) | ||
Nephrostomy tube | 1 (1.1) | 10 (1.8) | ||
Ureteral stent and nephrostomy | 5 (5.3) | 14 (2.5) | ||
Tubeless | 10 (10.5) | 108 (18.9) | ||
(n = 95) | (n = 571) |
Outcomes | LSD percutaneous n = 56 (30.8) | RSP percutaneous n = 126 (69.2) |
p value | Test |
---|---|---|---|---|
Total stone burden (mm2) median, [IQR] | 389, [228–676] | 280, [132–595] | 0.039 | C |
(n = 54) | (n = 107) | |||
Total stone diameter, median in mm, [IQR] | 41 [27–66] | 28 [18–68] | 0.063 | C |
(n = 54) | (n = 108) | |||
Density in hounsfield units, median, [IQR] | 950, [678–1189] | 900, [661–1020] | 0.22 | C |
(n = 45) | (n = 101) | |||
Stone location, n (%) | ||||
Renal pelvis | 10 (17.9) | 17 (13.5) | 0.14 | A |
Upper calix | 0 (0) | 8 (6.3) | ||
Middle calix | 1 (1.8) | 2 (1.6) | ||
Lower calix | 8 (14.3) | 21 (16.7) | ||
Staghorn stone | 8 (14.3) | 14 (11.1) | ||
Ureteral stone | 0 (0) | 10 (7.9) | ||
Multiple locations* | 29 (51.8) | 54 (42.9) | ||
(n = 56) | (n = 126) | |||
Pre-operative ureteral stent n (%) | 9 (16.1) | 19 (15.1) | 0.83 | B |
(n = 56) | (n = 126) | |||
Pre-operative percutaneous drain n (%) | 6 (10.7) | 27 (21.4) | 0.098 | B |
(n = 56) | (n = 126) | |||
Exit strategy | ||||
Ureteral stent** | 5 (8.9) | 8 (6.5) | 0.31 | A |
Nephrostomy tube | 28 (50.0) | 78 (63.4) | ||
Ureteral stent and nephrostomy | 23 (41.1) | 36 (29.3) | ||
Tubeless | 0 (0) | 1 (0.8) | ||
(n = 56) | (n = 123) | |||
Type of operation | ||||
PNL only*** | 9 (16.1) | 82 (65.1) | 0.001 | B |
ECIRS | 47 (83.9) | 44 (34.9) | ||
(n = 56) | (n = 126) |
Ureteroscopic procedures
Outcomes | LSD-URS n = 95 (14.3) | RSP-URS n = 571 (85.7) |
p value | Test |
---|---|---|---|---|
Intra-operative complications, n (%) | ||||
Overall | 3 (3.2) | 14 (2.5) | 0.72 | B |
Bleeding | 1 (1.1) | 3 (0.5) | 0.46 | B |
Perforation | 0 (0) | 10 (1.8) | 0.37 | B |
Avulsion | 0 (0) | 0 (0) | ||
Other | 2 (2.1) | 1 (0.2) | 0.055 | B |
(n = 95) | (n = 571) | |||
Post-operative complications, n (%) | ||||
Overall* | 13 (13.7) | 50 (8.8) | 0.13 | A |
Bleeding | 0 (0) | 3 (0.5) | 1.00 | B |
Fever (>38.0) | 7 (7.4) | 19 (3.3) | 0.080 | B |
UTI | 5 (5.3) | 17 (3.0) | 0.23 | B |
Sepsis | 4 (4.2) | 16 (2.8) | 0.51 | B |
Pain | 0 (0) | 13 (2.3) | 0.23 | B |
Death | 1 (1.1) | 1 (0.2) | 0.27 | B |
Other | 2 (2.1) | 1 (0.2) | 0.21 | B |
(n = 95) | (n = 571) | |||
Total blood transfusion rate, n (%) | 0 (0) | 6 (1.1) | 1.00 | B |
(n = 94) | (n = 571) | |||
Clavien grading score, n (%) | ||||
None | 82 (86.3) | 521 (91.2) | 0.12 | A |
1 | 0 (0) | 6 (1.1) | ||
2 | 11 (11.6) | 31 (5.4) | ||
3a | 0 (0) | 6 (1.1) | ||
3b | 0 (0) | 3 (0.5) | ||
4a | 1 (1.1) | 3 (0.5) | ||
4b | 0 (0) | 0 (0) | ||
5 | 1 (1.1) | 1 (0.2) | ||
(n = 95) | (n = 571) | |||
Failed procedures | 8 (8.4) | 30 (5.3) | 0.23 | B |
(n = 95) | (n = 571) | |||
Operation time minutes, median, [IQR] | 50, [40.5–68] | 41, [25–63] | <0.001 | C |
(n = 95) | (n = 570) | |||
Post-operative length of hospital stay | 1.0, [1.0–1.0] | 1.0, [1.0–1.0] | 0.83 | C |
days, median, [IQR] | (n = 94) | (n = 571) | ||
Stone-free rate | 58 (63.0) | 366 (67.7) | 0.39 | A |
(n = 92) | (n = 541) | |||
Method of evaluation | ||||
Computed tomography | 6 (6.3) | 20 (3.5) | 0.19 | A |
Ultrasound | 56 (58.9) | 430 (75.3) | <0.001 | A |
Intra-operative confirmation | 26 (27.4) | 106 (18.6) | 0.046 | A |
Other | 7 (7.4) | 15 (2.6) | 0.017 | A |
(n = 95) | (n = 571) | |||
Retreatment, n (%) | 18 (18.9) | 64 (11.2) | 0.034 | A |
(n = 95) | (n = 571) | |||
Readmission <3 months, n (%) | 19 (20.0) | 76 (13.4) | 0.088 | A |
(n = 95) | (n = 568) |
Percutaneous procedures
Outcomes | LSD percutaneous n = 56 (30.8) | RSP percutaneous n = 126 (69.2) |
p value | Test |
---|---|---|---|---|
Intra-operative complications, n (%) | ||||
Overall | 5 (8.9) | 7 (5.6) | 0.52 | B |
Bleeding* | 3 (5.4) | 4 (3.2) | 0.68 | B |
Ureteral perforation | 0 (0) | 2 (1.6) | 1.0 | B |
Mucosal damage of the ureter | 1 (1.8) | 1 (0.8) | 0.52 | B |
Ureteral avulsion | 0 (0) | 0 (0) | ||
Liver puncture | 1 (1.8) | 0 (0) | 0.31 | B |
Other | 0 (0) | 0 (0) | ||
(n = 56) | (n = 126) | |||
Post-operative complications, n (%) | ||||
Overall | 16 (28.6) | 44 (34.9) | 0.40 | A |
Bleeding | 3 (5.4) | 15 (11.9) | 0.28 | B |
Fever (>38.0) | 4 (7.1) | 8 (6.3) | 1.00 | B |
UTI | 6 (10.7) | 7 (5.6) | 0.22 | B |
Sepsis | 1 (1.8) | 8 (6.3) | 0.29 | B |
urinary leakage | 3 (5.4) | 2 (1.6) | 0.17 | B |
Death | 0 (0) | 1 (0.8) | 1.00 | B |
Other | 2 (3.6) | 10 (7.9) | 0.35 | B |
(n = 56) | (n = 126) | |||
Blood transfusion rate, n (%) | 3 (5.4) | 9 (7.1) | 0.76 | B |
(n = 56) | (n = 126) | |||
Clavien grading score, n (%) | ||||
None | 40 (71.4) | 82 (65.1) | 0.51 | A |
1 | 1 (1.8) | 3 (2.4) | ||
2 | 11 (19.6) | 18 (14.3) | ||
3a | 2 (3.6) | 14 (11.0) | ||
3b | 2 (3.6) | 5 (4.0) | ||
4a | 0 (0) | 3 (2.4) | ||
4b | 0 (0) | 0 (0) | ||
5 | 0 (0) | 1 (0.8) | ||
(n = 56) | (n = 126) | |||
Failed procedures | 1 (1.8) | 8 (6.4) | 0.28 | B |
(n = 56) | (n = 125) | |||
Operation time (minutes), median, [IQR] | 79.5, [62–101.5] | 75, [57–94] | 0.21 | C |
(n = 56) | (n = 125) | |||
Post-operative length of hospital stay (days), median, [IQR] | 4, [3–5] | 3, [2–4] | 0.086 | C |
(n = 56) | (n = 119) | |||
Stone-free rate in follow-up | 26 (50.0) | 45 (38.5) | 0.16 | A |
(n = 52) | (n = 117) | |||
Method of evaluation | ||||
Computed tomography | 11 (21.6) | 20 (17.5) | 0.33 | A |
Ultrasound | 35 (68.6) | 70 (61.4) | ||
Retrograde pyelogram | 0 (0) | 2 (1.8) | ||
Intra-operative confirmation* | 5 (9.8) | 22 (19.3) | ||
(n = 51) | (n = 114) | |||
Time until follow-up moment, weeks, median [IQR] | 8 [12] | 6 [4] | 0.008 | C |
(n = 46) | (n = 91) | |||
Retreatment, n (%) | 14 (25.5) | 45 (36.0) | 0.16 | A |
(n = 55) | (n = 124) | |||
Readmission <3 months, n (%) | 18 (32.1) | 47 (37.6) | 0.48 | A |
(n = 56) | (n = 125) |