Effect of microperc for treatment of renal calculi with self-made optical puncture needle combined with ureteral access sheath

Abstract

Objective To evaluate the effect of micropercutaneous nephrolithotomy(microperc) for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath. Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017, Male, 12 cases, female, 11 cases. The mean±SD (range) patient age was (49±14) years( 28-67 years), stone volume was (1.7±0.6) cm(1.0-3.0 cm) and stone density was (934.5±282.7) HU(357-1 500 HU). The self-made all-seeing system consists of a puncture needle (F4.85) and two 3-way connector allowing the insertion of a flexible microoptic system, laser fiber and attaching to irrigation system. Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation. The course of puncture could be all-see on the display which was connected with flexible microoptic system. After stone fragmentation, the procedure was terminated in tubeless fashion. Ureteral double J stent was inserted in order to prevent postoperative complications. The factors analysed were demographic variables including age, sex, stone volume, stone density [Hounsfield units (HU)] and stone location, and intra- and peri-operative variables such as operating time, drop in haemoglobin level, stone clearance and complications. Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision. The mean±SD(range) operation duration was (46.2±19.9) min(20-120 min), pain score was 2.8±1.2(1-6), hemoglobin decrease was 6.6 g/L, and in hospital time was (2.9±0.8) d(2-5 d) , respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months postoperation was 90.9%(20/22) and 100 %(22/22), respectively. Two who suffered hematuria(Clavien Ⅰ)underwent conservative treatment and recorered well. One suffered urinary tract infections(ClavienⅡ) and was treated with antibiotics. There were no major complications. Conclusions Mircoperc with the self-made device and ureteral access sheath in management of renal calculi is feasible and effective. Key words: Micropercutaneous nephrolithotomy; Optical puncture needle; Ureteral access sheath; Renal calculi; Percutaneous nephrolithotripsy