Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2017-12-21 Cooperative journals: 《南方医科大学学报》
Abstract： Objective To compare the efficacy and safety of staged retrograde flexible ureteroscopic lithotripsy (FURS) and miniaturized percutaneous nephrolithotomy (m-PCNL) for treatment of renal stones of 2-4 cm in diameter. Methods This randomized controlled trial was conducted in 70 patients with renal stones of 2-4 cm in diameter admitted in our hospital between January 2013 and December 2015. The patients were randomized to receive staged FURS (35 cases) or m-PCNL (35 cases), and the total treatment time, total hospital stay after procedure, total medical cost, treatment success, decrease in hemoglobin level and complications were compared between the two groups. Results The treatment success rate was 100% in both groups, but the complete stone-free rate was significantly lowered in FURS group than m-PCNL group (65.71% vs 94.29%, P<0.01). The average decrease in hemoglobin level was 3.37±1.56 g/L in FURS group and 11.93±2.24 g/L in m-PCNL group (P<0.01). The overall complication rates in the two groups were 6.25% and 9.37%, respectively (P>0.05). Minor complications (grade I by Clavien-Dindo classification) occurred in one case in FURS group (fever) and two cases in m-PCNL group (self-limiting hematuria); major complications (grade II) occurred in one case in FURS group (steinstrase) and one case in m-PCNL group (blood transfusion). In staged FURS and m-PCNL groups, the mean total treatment time was 4.06±1.11 vs 1.26±0.47 weeks (P<0.01), the mean hospital stay after procedure was 3.66±1.29 vs 5.13±0.43 days (P<0.01), and the mean total medical cost was ￥54 291.00±6149.00 vs ￥23 482.00±2317.00 (P<0.01), respectively. Conclusion FURS is safe and effective for treatment of renal stones of 2-4 cm in diameter, and a staged procedure is necessary to achieve a stone-free status for large calculi. Both sophisticated equipment and rich surgical experience are essential to ensure treatment success.
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2017-12-07 Cooperative journals: 《南方医科大学学报》
Abstract： Objective To compare the incidences of complications associated with 3 different endoscopic procedures, namely transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the Clavien-Dindo classification system for standardizing the evaluation of the complications. Methods Between January 2010 and December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207 cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo classification system. Results There was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP group (P<0.05); no significant difference was found in grade I or V complications among the 3 groups (P>0.05). Conclusion According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to standardized evaluation of surgical complications but still needs further modifications for better performance.
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