AB199. Investigation of flexible ureteroscope and percutaneous nephrolithotomy in treatment of renal calculi (1–2 cm) on the effects of inflammatory reaction

Objective: By detecting stress indicators related to discuss retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) those two different operations impact on the body’s inflammatory reaction, for renal calculi disease surgical methods of clinical evidence.

Methods: Randomly 80 patients suffer unilateral renal calculi which 1–2 cm from September 2013 to September 2014 in the urology department of Guangdong No.2 Provincial People’s Hospital, Divide into flexible ureteroscope lithotripsy group 40 cases (group RIRS) and 40 cases in percutaneous nephroscopy group (group PCNL). Flexible ureteroscope lithotripsy group (21 males, 19 females); percutaneous nephroscopy group (20 males, 20 females). Respectively using peripheral venous blood of 10 mL of patients in the preoperative and postoperative 1 hour, postoperative 1^st, 3^rd, 5^th day to adopt fully automatic blood cell analyzer to make determination of peripheral white blood cells (WBC), immune turbidity method to analysis concentration of blood C reactive protein (CRP), radioimmunoassay to measure blood concentration of cortisol (Cor), enzyme linked immunosorbent assay (ELISA) to measure interleukin 6 (IL-6) and interleukin 10 (IL-10) concentration. All the data using SPSS statistical software for statistical analysis, P<0.05 said the difference was statistically significant.

Results: (I) Related conditions of the operation. (i) Efficacy of the lithotripsy: group RIRS of patients with calculi one-time clearance rate was 87.5% (35/40), two cases of renal calyx calculi patients need DURL and had a successful treatment, one case of renal calyx diverticulum for the flexible ureteroscope rotation angle limit had failed to lithotripsy. The total clearance rate of renal calculi was 97.5% (39/40); group PCNL of patients with calculi one-time clearance rate was 85% (34/40), two cases of patients after the 2^nd phase PCNL succeed, two cases with residual stone more than 2 mm. The total clearance rate of renal calculi was 95% (38/40). There was no statistically significant difference (P>0.05). (ii) Intraoperative condition: compared with the time of operation of group RIRS and group PCNL, there was no statistically significant difference (P>0.05). But the intraoperative blood loss, RIRS group less than group PCNL, there was statistically significant difference (P<0.05). (iii) Postoperative condition: stomach intestine functional recovery after the operation of group RIRS was earlier than group PCNL, there was statistically significant difference (P<0.05). Postoperative patients’ out-of-bed activity time and average day in hospital of group RIRS were less than group PCNL, comparing differences between the two groups have statistical significance (P<0.05). (iv) Adverse reactions: there were two cases of hyperpyrexia in group RIRS postoperative patients (temperature >39.0°), the anti-infection short-term improvement in discharged after symptomatic treatment. there also were two cases of hyperpyrexia in group PCNL postoperative patients (temperature >39.0°), the anti-infection short-term improvement in discharged after symptomatic treatment. One patient with bacteremia was recorded by positive anti-infection anti-shock symptomatic support hospital cured after treatment. One case of late-onset rebleeding after 12 hours, cured by DSA embolization before hospital discharge. (v) The postoperative visual analogue scale (VAS) pain scores. In 5 days after surgery, the difference between group RIRS and PCNL resting VAS pain scores was statistically significant (P<0.05), and group RIRS was obviously lower PCNL group in the activity of VAS pain scores (P<0.05). Two groups of patients with resting VAS pain score is lower than activity VAS pain scores (P<0.05). (II) inflammatory reaction. (i) Comparison in the group: compared with preoperative, IL-6, IL-10, Cor, WBC was elevated obviously and reach peak in postoperative day 1, through a slight decline, it had a basic return to normal level in postoperative day 5. CRP was elevated obviously in postoperative 1 hour, peak appears in the day 1, and was still higher than normal till day 5. (ii) Comparison between groups: all preoperative indicators had no significant difference between two groups; the increased stress indexes level of group RIRS in 1 hour after operation, postoperative day 1, 3, 5 was less than group PCNL, there was an obvious difference of statistical significance.

Conclusions: Surgical trauma can cause the release of inflammatory factor increases, the anti-inflammatory cytokine secretion will also increase. Compare with percutaneous nephroscopy lithotripsy, flexible ureteroscope lithotripsy which would cause inflammatory reaction of body while treating renal calculi diseases is lower. It also had a lower incidence of adverse reactions after surgery and a faster postoperative recovery.

Keywords: Renal calculi; inflammatory reaction; cytokines; renal calculi