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Management of nephrolithiasis is evolving rapidly, and various minimally-invasive urological procedures are currently available for treating patients with renal stones, including extracorporeal shockwave lithotripsy (ESWL), flexible ureteroscopy (f-URS) and miniaturised percutaneous nephrolithotomy (mini-PCNL).
Despite being the only truly-non-invasive, outpatient procedure, stone-free rates (SFRs) of ESWL are lower than both mini-PCNL and f-URS. Furthermore, ESWL has several limitations, such as pregnancy; uncorrected coagulopathy;aortic aneurism; severe obesity; large stone burdens (>2cm); stones with high densities (>970/1000 Hounsfield units); ESWL-resistant stone compositions; lower calyceal stones with unfavourable anatomical criteria; and stones in calyceal diverticula; Morbidities of the conventional PCNL are significantly minimised by using less access diameters in PCNL while providing comparable SFRs. Additionally, Mini and Micro PCNL result in shorter hospital stay and higher tubeless rates compared to conventional PCNL.
Flexible ureteroscopy has been increasingly used as a primary modality for treatment of renal stones with significantly lower complication rates than PCNL and mini-PCNL in terms of less bleeding and transfusion rates, shorter hospital stay and less postoperative pain. Additionally, f-URS is the only treatment modality of nephrolithiasis that can be safely and effectively used in patients with bleeding tendency, as well as pregnant women; moreover, its outcomes are not affected by obesity. Nevertheless, its poor durability and high costs remain major limitations for f-URS, especially in developing countries.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| f-URS |
| ||
| mini-PCNL |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Flexible ureteroscopy | Procedure | The procedure will be performed in an endourology room where a radiolucent operative table together with a C-arm, a video-camera unit and a Laser device are available. Irrigation fluids include normal saline and/or sterile water. |
| Measure | Description | Time Frame |
|---|---|---|
| initial stone clearance | Number of participants who has been totally cleared of stones as measured by KUB and ultrasound | 24 hours after the operation |
| final stone clearance | Number of participants who has been totally cleared of stones as measured by non-contrast CT | 90 days after the operation |
| Measure | Description | Time Frame |
|---|---|---|
| Operative time | time passed during the operation | Within 24 hours |
| Hospital stay | Number of days the patient has been hospitalised | Within a week from the operation |
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Inclusion Criteria:
Exclusion Criteria:
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no specific criteria
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Assiut Urology and Nephrology Hospital | Asyut | Asyut Governorate | 71515 | Egypt |
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| ID | Term |
|---|---|
| D053040 | Nephrolithiasis |
| ID | Term |
|---|---|
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
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| mini-Percutaneus nephrolithotomy | Procedure | The procedure is done in the prone position under fluoroscopy guidance with a semi-rigid 12Fr. Nephroscope |
|
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| Haemoglobin drop | The percentage of haemoglobin drop before and after the operation | within 24 hours |
| D000091642 | Urogenital Diseases |
| D052878 | Urolithiasis |
| D052801 | Male Urogenital Diseases |