Abstract
The incidence of small- and medium-size renal stones is rising. Stone clearance, bleeding, urine leak, and infectious complications are major concerns for urologists. They can choose the best technique from a list of armamentarium available. Minimally invasive approach like percutaneous nephrolithotomy (PCNL) has significantly influenced renal stone management since 1976. Miniaturization of the instruments innovate more effective and safer alternatives for urolithasis management. The outcome of mini-PCNL is explored and compared with standard PCNL in this review. Original research articles were reviewed using a systematic approach (keyword electronic database search). Duplicates were excluded in each step and 19 original articles out of 156 hits were analyzed. Mini-PCNL has significantly less bleeding complications and hospital stay. There were no significant difference in stone free rate between mini-PCNL and standard PCNL. The stone-free rate and complications rates were less dependent on the technique of puncture, tract dilatation, and energy used to fragment stones. The total operative time became slightly longer in mini-PCNL attributed to the sheath size and stone fragments retrieval. We found that mini-PCNL is as effective as standard PCNL with fewer complications. Stone burden is the key factor responsible for overall stone-free rate. However, the recommendation is limited by quality of study and the sample sizes.
Highlights
The incidence of small- and medium-size renal stones is rising
We found that mini-percutaneous nephrolithotomy (PCNL) is as effective as standard PCNL with fewer complications
Lahme recommended miniPCNL to treat all kinds of upper urinary tract calculi greater than 10 mm in diameter and it is regarded as a treatment alternative to flexible ureterorenoscopic lithotripsy (URSL), shock wave lithotripsy (SWL), and conventional PCNL.[22]
Summary
The incidence of small- and medium-size renal stones is rising. Stone clearance, bleeding, urine leak, and infectious complications are major concerns for urologists. Invasive approach like percutaneous nephrolithotomy (PCNL) has significantly influenced renal stone management since 1976. There were no significant difference in stone free rate between mini-PCNL and standard PCNL. The international guidelines recommend percutaneous nephrolithotomy (PCNL) as the first line of treatment for renal stones more than 20 mm in size. Whereas for stones of size 10 to 20 mm the treatment options can be shock wave lithotripsy (SWL), PCNL, or retrograde intrarenal surgery (RIRS).[3,4] The procedure PCNL has evolved since 1976 and has undergone many modifications and refinements in the techniques and the instruments to achieve maximum stone clearance with minimal complications. We are revisiting the mini-PCNL, reviewing and comparing its success in management of renal stones
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