Comparative Evaluation of the Choice of the Method of Percutaneous Nephrolithotripsy in Patients with Nephrolithiasis

Abstract

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p<0.001), mCPNL was more often finished with drainageless methods (41.1% vs. 6.8%; p<0.001). The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p>0.05) and in treatment of coral-like (90.1% vs. 77.3%; p<0.05) and multiple nephrolithiasis (89.5% vs. 70.8%; p=0.03). The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p<0.001). The infectious complications frequency and length of postoperative stay in the hospital were less in the mPCNL group than in the sPCNL group – 7.3% vs. 13.2% (p=0.03) and 1.9±0.6 days vs. 4.3± 2.4 days, respectively (p<0.001). Conclusions. Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.