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ORIGINAL RESEARCH article

Front. Med.
Sec. Nephrology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1464491

RIRS with FV-UAS vs.ESWL for the management of 1-2-cm lower pole renal calculi in obese patients: a prospective study

Provisionally accepted
zhang sicong zhang sicong 1wang qing wang qing 2Li Yunpeng Li Yunpeng 2*wu jie wu jie 3
  • 1 Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
  • 2 Nanjing Jiangning Hospital, Nanjing, China
  • 3 Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with fexible vacuum-assisted ureteral access sheath (FV-UAS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of 1-2 cm lower pole renal calculi (LPC) in obese patients.This prospective, randomized study included 149 obese patients with 1-2 cm LPC. Patients were allocated into two groups: 76 patients underwent RIRS with FV-UAS, and 73 patients received ESWL.The parameters assessed included stone-free rate (SFR), retreatment rate, complications, operative time, and pain intensity measured by the Visual Analog Scale (VAS).Stone-free status was defined as the absence of stones on computed tomography or residual fragments smaller than 4 mm at 4 weeks post-procedure.The baseline characteristics of the two groups were comparable.The SFR was significantly higher in the RIRS group, reaching 86.8%, compared to 63.0% in the ESWL group (P = 0.034). Furthermore, the retreatment rate was significantly lower in the RIRS group, at 5.2%, versus 24.7% in the ESWL group (P < 0.001). The average operative time for RIRS was notably longer, at 65.3 ± 6.4 minutes, compared to 25.3 ± 7.8 minutes for ESWL (P < 0.001). The complication rates were 9.2% for the RIRS group and 6.8% for the ESWL group, with no statistically significant difference (P = 0.326). All complications were classified as Grade I or II according to the modified Clavien classification system. No significant differences were observed between the two groups regarding pain VAS scores and the composition of the stones. Conclusions RIRS with FV-UAS demonstrated superior efficacy, evidenced by a higher SFR and reduced retreatment rates compared to ESWL, despite a longer operative duration. Both treatment modalities showed comparable safety profiles. RIRS with FV-UAS emerges as a viable, effective, and reproducible intervention for managing 1-2 cm LPC in obese patients, providing significant clinical advantages.

    Keywords: lower pole renal calculi, Obesity, Flexible ureteroscopy, Extracorporeal shock wave lithotripsy, combination therapy

    Received: 14 Jul 2024; Accepted: 11 Oct 2024.

    Copyright: © 2024 sicong, qing, Yunpeng and jie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Li Yunpeng, Nanjing Jiangning Hospital, Nanjing, China

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