Evaluation of Different Treatment Modalities for Lower Pole and Renal Pelvis Stones

Study Overview
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Brief Summary
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It is aimed to evaluate the treatment results, rates of success and complications, and injury given to the kidney by measuring preoperative and postoperative blood urea, creatinine, Cystatin C and Netrin-1 levels and urine Cystatin C and Netrin-1 levels in patients with lower pole or renal pelvis stone(s) undergoing either one of the treatment modalities including conventional percutaneous nephrolithotripsy (PCNL), mini PCNL, ultra-mini PCNL, micro PCNL, retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESWL).

Detailed Description
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In this study, the demographic and preoperative data, imaging data, operative data and postoperative follow-up data will be prospectively recorded according to the patient information forms for the patients with lower pole and/or renal pelvis stone(s) who will undergo either one of the treatment modalities including conventional PCNL, mini PCNL, ultra-mini PCNL, micro PCNL, RIRS and ESWL. A total of 300 (three hundred) patients, aging between 18 and 70 years, with similar stone size and location are being planned to be enrolled into the study; and will be prospectively randomized into one of six groups with a 1:1 ratio. By this means, conventional PCNL will performed to 50 (fifty) patients, mini PCNL will be performed to 50 (fifty) patients, ultra-mini PCNL will be performed to 50 (fifty) patients, micro PCNL will be performed to 50 (fifty) patients, while 50 (fifty) patients will undergo RIRS and 50 (fifty) patients will undergo ESWL. Preoperatively, blood Cystatin C and Netrin-1, and urine Neutrophil gelatinase-associated lipocalin (NGAL), Cystatin C and Netrin-1 levels will be measured. After the treatments, blood Cystatin C and Netrin-1 levels at postoperative 6th, 12th, 24th and 48th hours will be recorded. Cystatin C and Netrin-1 levels in urine will be measured at postoperative 12th and 24th hours, while urine NGAL levels will be measured at postoperative 12th and 72nd hours. Besides these, classical kidney function tests, namely blood urea and creatinine levels, will be measured preoperatively and postoperatively at 24th and 48th hours. Parameters listed below will be also recorded and evaluated: Preoperative general evaluation data: Age, height, weight, body-mass index, concomitant comorbidities, prescriptions used, history of operation(s), American Society of Anesthesiologists (ASA) score Preoperative urological evaluation data: History of ESWL/PCNL/ureterorenoscopy (URS)/RIRS/open surgery, whole blood count, kidney function tests, automatic urine test, urine culture, preoperative imaging modality (KUB, US, CT), number-dimensions-localization-composition of stone(s), existence of hydronephrosis Operative data: Access fluoroscopy duration, total access duration, total fluoroscopy duration, operation duration, use of double-J stent, preoperative complications Number of previous ESWL seance, total duration of ESWL, number of shots during ESWL (if any) Follow-up data: Urethral catheterization time, hospitalization time, need of any other treatment for being stone-free, time to full stone-free, duration to removal of double-J stent, existence of residual stone(s), formation of new stone(s), complications in late time, medical prophylaxis Stone analysis

Official Title
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Comparison of Success Rates, Complication Rates and Injury to Kidneys of Conventional PCNL, Mini PCNL, Ultra-mini PCNL, Micro PCNL, RIRS and ESWL in the Treatment of Lower Pole and Renal Pelvis Stone(s)

Conditions
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Kidney Stones

Intervention / Treatment
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* Procedure: Endoscopic kidney stone surgery
* Procedure: Endoscopic kidney stone surgery
* Procedure: Endoscopic kidney stone surgery
* Procedure: Endoscopic kidney stone surgery
* Procedure: Endoscopic kidney stone surgery
* Procedure: Non-invasive kidney stone treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients planned to undergo either conventional PCNL, mini PCNL, ultra-mini PCNL, micro PCNL, RIRS or ESWL due to kidney stone(s) Patients between 18 and 70 years old Exclusion Criteria: Patients with unregulated diabetes mellitus and diabetic nephropathy Patients with a blood pressure higher than 140/80 mmHg despite use of antihypertensive drug(s) regularly Patients with chronic renal failure who need dialysis Patients who had prerenal, renal or postrenal acute kidney failure during the last 6 months Patients who had acute pyelonephritis during the last 6 months Patients younger than 18 years old or older than 70 years old Patients who had kidney surgery during the last 3 months and who have abnormal kidney functions Patients with ureteral stone who are planned to undergo endoscopic stone treatment at the same time Patients with a history of corticosteroid use during enrollment into the study or previous 3 months Patients with uncontrolled thyroid disease Patients who have a disease with rapid cell turn-over (like leukemia, lymphoma, etc.) Patients in whom PCNL/RIRS/ESWL cannot be performed due to any reason and the procedure is terminated Patients who are converted to open surgery due to any reason Patients with missing data

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional PCNL<br>Endoscopic kidney stone surgery: Patients will undergo conventional percutaneous nephrolithotripsy. | Procedure: Endoscopic kidney stone surgery<br>* Conventional PCNL will be performed.<br>|
| Active Comparator: Mini PCNL<br>Endoscopic kidney stone surgery: Patients will undergo mini percutaneous nephrolithotripsy. | Procedure: Endoscopic kidney stone surgery<br>* Mini PCNL will be performed.<br>|
| Active Comparator: Ultra-mini PCNL<br>Endoscopic kidney stone surgery: Patients will undergo ultra-mini percutaneous nephrolithotripsy. | Procedure: Endoscopic kidney stone surgery<br>* Ultra-mini PCNL will be performed.<br>|
| Active Comparator: Micro PCNL<br>Endoscopic kidney stone surgery: Patients will undergo micro percutaneous nephrolithotripsy. | Procedure: Endoscopic kidney stone surgery<br>* Micro PCNL will be performed.<br>|
| Active Comparator: Retrograde intrarenal surgery<br>Endoscopic kidney stone surgery: Patients will undergo retrograde intrarenal surgery. | Procedure: Endoscopic kidney stone surgery<br>* Retrograde intrarenal surgery will be performed.<br>|
| Active Comparator: Extracorporeal shock wave lithotripsy<br>Non-invasive kidney stone treatment: Patients will undergo extracorporeal shock wave lithotripsy. | Procedure: Non-invasive kidney stone treatment<br>* Extracorporeal shock wave will be performed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stone-free rate | Determination of any residual stone in the collecting system by using one of imaging modalities. | Within the first 30 days after surgery/procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complication rate | Determination of any complications related to the surgery/procedure. | Within the first 30 days after surgery/procedure | 
| Blood Cystatin C level (mg/L) | Determination of any impairment in renal function after the surgery/procedure by measuring blood Cystatin C level. | Within the first 48 hours after surgery/procedure | 
| Blood Netrin-1 level (pg/mL) | Determination of any impairment in renal function after the surgery/procedure by measuring blood Netrin-1 level. | Within the first 48 hours after surgery/procedure | 
| Urine NGAL level (ng/mL) | Determination of any impairment in renal function after the surgery/procedure by measuring urine NGAL level. | Within the first 72 hours after surgery/procedure | 
| Urine Cystatin C level (mg/L) | Determination of any impairment in renal function after the surgery/procedure by measuring urine Cystatin C level. | Within the first 24 hours after surgery/procedure | 
| Urine Netrin-1 level (pg/mL) | Determination of any impairment in renal function after the surgery/procedure by measuring urine Netrin-1 level. | Within the first 24 hours after surgery/procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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kidney stone, percutaneous nephrolithotripsy, retrograde intrarenal surgery, extracorporeal shock wave lithotripsy, mini PCNL, ultra-mini PCNL, micro PCNL