Nefrolitotomía percutánea con técnica miniperc en posición supina: experiencia inicial

Abstract

BackgroundThe mini-percutaneous nephrolithotomy technique has been used as an alternative to conventional percutaneous nephrolithotomy for the treatment of small-volume kidney stones. There are few descriptions of this technique and even fewer in the supine position. AimsTo evaluate the safety and efficacy of the “mini-perc” technique in the supine position for the treatment of small-volume stones. MethodsA retrospective study reviewing the case records of patients that underwent supine mini-percutaneous nephrolithotomy within the time frame of December 2012 to January 2014 was conducted. Patients underwent the procedure as initial or second-line treatment if they had a single stone smaller than 1.5 cm with a calyceal anatomy that did not lend itself to flexible ureterorenoscopy. A 15 Fr operating tube was employed, and either the Valdivia or the Valdivia/Galdakao positions were used. The variables of surgery duration, stone-free rate, and complications were evaluated. ResultsThe series included 10 cases. Mean patient age was 37.7 years (range: 20-59), 4 patients were men and 6 were women, and the mean body mass index was 27.4 kg/m2 (range: 24-30). The previous failed therapies were: 4 extracorporeal lithotripsies, and 1 ureteroscopy. The mean cumulative area was 227 mm2 (range: 180-250). Intrarenal stone location was: 6 lower calyx, 2 middle calyx, and 2 upper calyx; mean surgery duration was 70.5 min (range: 40-100); and the stone-free rate was 90%. In relation to residual lithiasis management, one patient was treated with conventional percutaneous nephrolithotomy. ConclusionsThis technique has been in use for 16 years; it is effective in treating small-volume stones and is a good alternative when other therapies have failed. The procedure is versatile and safe, with the known advantages of the supine position. In addition, the one-shot tract creation results in less radiation exposure for the surgeon.