A comparison among PCNL, miniperc and ultraminiperc for lower calyceal stones between 1 and 2 CM : A multicenter experience

INTRODUCTION AND OBJECTIVES We performed a prospective randomized comparison among PerCutaNeous Lithotripsy (PCNL), MiniPerc (MP) and UltraMiniPerc (UMP) for lower calyceal stones between 1 and 2 cm to evaluate the efficacy and the safety of these procedures. METHODS Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm wereenrolled in this multicentric study. Exclusion criteria were the presence of coagulation impairments, age less than 18 or more then 75, presence of acute infection, presence of cardiovascular or pulmonary comorbidities. Patients were randomized into three groups: Group A: patients treated with PCNL; Group B: patients treated with MP; Group C: patients treated with UMP. Patients were controlled with abdomen X ray and CT scan after 3 months. A negative X ray or an asymptomatic patients with stone fragments less than 3 mm big. and a negative urinary colture were the criteria to assess the stone-free status. A statistical analysis was carried out to asses patients data, success and complications rates, re-treatment rate and need for auxiliary treatment. RESULTS Between January 2014 and June 2016, 132 consecutive patients were enrolled in this study. 44 pts for the group A, 47 for group B and 41 for group C. The mean stone size was 16.38 mm. in g roup A, 17.82 mm. in Group B and 15.23 mm. in Group C (p=0.34). The overall stone free rate was 86.3% for group A, 82.9% for group B and 78.0 % for group C. The retreatment rate was significantly higher in group C compared to the other two groups, 12.1% (p<0.05). The auxiliary procedure rate was comparable for group A and B and C (p>0.05). The complication rate was 13.6%, 4.2% and 2.4% respectively for group A, B and C. CONCLUSIONS PCNL and MP were more effective than UMP to obtain a better stone free rate. Auxiliary and re-treatment rate were similar. On the other hand for such this kind of stones PCNL had more complications. MP and UMP find a better indication in stones less than 1.5 cm in size.