JCU - January 2022 - 9

Irani et al.
9
Table 1. Stone characteristics and recurrence rate between the antegrade and retrograde groups.
Variables
Groups
Operation side, left/right
History of previous ipsilateral renal surgery, positive/negative
Stone size, M±SD
Renal pelvis stones, n (%)
Lower calyseal stones,a n (%)
Others,a n (%)
aDiverticular stones are categorized in the calyceal stone category.
SD: standard deviation.
Table 2. Surgical outcome in the antegrade and retrograde groups.
Variables
Groups
Operation time (minutes), M±SD
Radiation time (seconds), M±SD
Single session stone, free rate, n (%)
Stone migration, to ureter, n (%)
Ancillary procedures, n (%)
Need for blood transfusion, n (%)
Postoperative haemoglobin drop (g/dL), M±SD
Postoperative creatinine change (mg/dL), M±SD
Results
The two groups were similar regarding sex (p=0.84) and
age (p=0.65). The mean age of the patients recruited in the
study was 42.9±13.5 years in the stone-directed group and
44.1±13.3 years in the retrograde group (p=0.65). The
mean stone size was 26.3±8.2 mm in the antegrade group
versus 26.7±8.2 mm in the retrograde group (p=0.82), and
the two groups were the same in terms of stone location
(p=0.91). Patient information and the characteristics of
their stones are outlined in Table 1.
Table 2 shows a summary of the surgical outcome and
the complications reported in each group. There was no
statistically significant difference between the two groups
(stone-directed vs. retrograde) concerning postoperative
haemoglobin drop (0.9±0.5 g/dL vs.
1.0±0.6 g/dL;
p=0.71), creatinine levels (0.3±0.2 mg/dL vs. 0.3±0.2
mg/dL; p=0.57), the need for blood transfusion (2 vs. 3
cases; p=0.99) and pyelonephritis (1 vs. 2 cases; p=0.99).
Moreover, radiation time during access (104.4±42.6
Antegrade N=50
49.8±10.4
104.4±42.6
48 (96.0)
3 (6.0)
5 (10.0)
2 (4.0)
0.9±0.5
0.3±0.2
Retrograde N=50
63±12.2
101.5±41.5
46 (92.0)
2 (4.0)
4 (8.0)
3 (6.0)
1.0±0.6
0.3±0.2
Antegrade N=50
24/26
5/45
26.3±8.2
14 (28.0%)
18 (36.0%)
18 (36.0%)
Retrograde N=50
22/28
4/46
26.7±8.2
15 (30.0%)
19 (38.0%)
16 (32.0%)
p-Value
0.69
0.99
0.82
0.72
0.91
0.65
p-Value
<0.001
0.73
0. 68
0.99
0.99
0.99
0.71
0.57
seconds vs. 101.5±41.5 seconds; p=0.73), stone-free rate
and stone migration to the ureter (3 versus 2 cases; p=0.99)
were not statistically different between the two groups.
Ancillary procedures included three ureteroscopy
(URS), two SWL in the antegrade group and two URS and
two SWL in the retrograde group without a statistically
significant difference between the two groups (p=0.99). A
single puncture was achieved to remove the calyceal,
diverticular, partial staghorn and staghorn stones in 72.2%
of the antegrade and 78.9% of the retrograde group. The
difference was not statistically significant (p=0.69). A double
puncture was required in 71.9% of the antegrade and
9.4% of the retrograde group to remove the renal pelvis
stones (p<0.001).
A JJ stent was inserted in13 (26.0%) patients in the
antegrade group and in 10 (20%) patients in the retrograde
group (p=0.634). Totally tubeless PCNL was seen in 14
(28.0%) patients in the antegrade group and in one (2.0%)
patient in the retrograde one (p=0.0008).

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