Stone clearance rate and postoperative recovery of mini percutaneous nephrolithotomy: A single-institute study

Abstract

Introduction: During the last two decades, the evaluation and management of renal and upper ureteric stones have vastly altered. The era of endoscopic surgery replaced open pyelolithotomy or nephrolithotomy which caused significant morbidity. Earlier percutaneous nephrolithotomy (PCNL) replaced open surgery as a safe and effective treatment for renal stones. During this decade, we saw the evolution of endoscopic surgery where Mini PCNL (Mini Perc), Ultra Mini, and Micro Perc have further achieved stone clearance with better outcomes pertaining to reduced morbidity because of reduction in the caliber of tract dilatation, even avoiding a nephrostomy postprocedure in select cases. Aim: The aim of this study summarizes the outcome of 78 cases of patients undergoing Mini Perc. The primary objectives of the study are: 1. Postoperative evaluation of complications associated with Mini Perc by Modified Clavien–Dindo Grading 2. Postoperative pain assessment by visual analog scale 3. Stone clearance rate of the surgical procedure. Settings and Design: The research was carried out in the form of a hospital-based prospective observational study as per the guidelines shared by the Prospective Observational Clinical Studies Good Research Practices Task Force (formed May 16, 2010). Seventy-eight patients who underwent Mini Perc between August 2018 and May 2020 at tertiary care centers and who were vetted against the inclusion criteria were included in the study. Subjects and Methods: This was a hospital-based prospective observational study of 78 consecutive patients who underwent Mini Perc between August 2018 and May 2020 at a tertiary care center and were vetted against the criteria for inclusion and exclusion. A total of 78 patients who met the inclusion criteria were followed up in the study. The management policy for pelvicalyceal calculi at the study center has closely followed those of the American Urological Association (AUA) guidelines for managing renal stones. Results: The mean age of the group was 43.3 years (range: 16–84) with 47 males and 38 females. The mean stone size was 20.11 mm (range 11–8 mm) and the mean operative time was 44.5 min (range: 29–98 min). Double J (DJ) stent was placed in all patients as a prophylaxis to prevent obstruction/postoperative urinary leak. Postoperatively, three patients had bleeding from the operated site, two patients survived sepsis, and one patient each had postoperative fever and pleural injury. Pain assessment done at specified intervals showed a progressive decreasing trend in intensity as evaluated by visual analog scale. The stone clearance rate in our study was 96.15% at the end of 1 month following postoperative period. Conclusion: The study shows that Mini Perc remains the standard of care for the management of renal and upper ureteric stones. The technique beyond doubt is safe, efficient, feasible, and economical in achieving excellent stone clearance rates. The Modified Clavien–Dindo system of grading for perioperative complications is easy to use and reproducible. It can be used as an objective and reliable method for describing the complications of the surgical procedure.