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Minerva Urology and Nephrology 2022 Feb 11

DOI: 10.23736/S2724-6051.22.04664-X


language: English

Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys

Ee J. LIM 1 , Jeremy Y. TEOH 2, Khi Y. FONG 3, Esteban EMILIANI 4, Nariman GADZHIEV 5, Dmitry GORELOV 6, Yiloren TANIDIR 7, Fabio SEPULVEDA 8, Abdullah AL-TERKI 9 , Sanjay KHADGI 10, Abhay MAHAJAN 11, Deepak RAGOORI 12, Govindarajan RAMALINGAM 13, Vaddi C. MOHAN 14, Arvind P. GANPULE 15, Santosh KUMAR 16, Daniele CASTELLANI 17, Manoj MONGA 18, Scoffone CESARE 19, Fabio C. VINCENTINI 20, Olivier TRAXER 21, Bhaskar K. SOMAN I22, Vineet GAUHAR 23

1 Department of Urology, Singapore General Hospital, Singapore; 2 Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China; 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 4 Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain; 5 Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia; 6 Endourology Department, Saint-Petersburg State Medical University Hospital, Saint-Petersburg, Russia; 7 Department of Urology, Marmara University School of Medicine, Istanbul, Turkey; 8 Department of Urology, Brigadeiro Hospital, Sao Paulo, Brazil; 9 Section of Urology, Department of Surgery, Al-Amiri Hospital, State of Kuwait; 10 Khadgi Institute of Endourology, Lalitpur, Nepal; 11 Sai Urology Hospital, Aurangabad, India; 12 Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, India; 13 Department of Urology, Jeyam Multispeciality Hospital, Tamil Nadu, India; 14 Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India; 15 Department of Urology, Urology Muljibhai Patel Urological Hospital, Nadiad, Gujarat; 16 Christian Medical College, Vellore, India; 17 Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy; 18 Department of Urology, University of California San Diego, CA, USA; 19 Department of Urology, Cottolengo Hospital, Turin, Italy; 20 Endourology Section, Brigadeiro Hospital, São Paulo, Brazil; 21 Department of Urology Hôpital Tenon, Sorbonne University, Paris, France; 22 Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; 23 Ng Teng Fong General Hospital, NUHS, Singapore


BACKGROUND: Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys.
METHODS: A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (Horseshoe kidney(HSK), ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable.
RESULTS: After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95%-CI=1.91-7.46, p<0.001), particularly in HSK (OR=3.33, 95%-CI=1.22-9.99, p=0.023), and ectopic kidneys (OR=18.10, 95%-CI=3.62-147.63, p=0.002), with no significant difference in malrotated kidneys. There was no significant difference in post-operative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs 0%, p=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias.
CONCLUSIONS: While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in post-operative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.

KEY WORDS: Anomalous kidneys; Percutaneous nephrolithotomy (PCNL); Retrograde intrarenal surgery (RIRS)

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