Tubeless mini-percutaneous nephrolithotomy for the treatment of renal and upper ureteral stones of ≥3 cm in diameter

Abstract

Purpose: To assess the outcome and safety of tubeless mini-percutaneous nephrolithotomy (mini-PCNL) to treat patients with renal and upper ureteral stones ≥3 cm. Materials and Methods: Between March 2017 and September 2019, 82 patients who underwent tubeless mini-PCNL at our hospital were evaluated. The patients had renal and upper ureteral stones of a size ≥3 cm in maximal dimension. A 15-Fr operating nephroscope was used. The patients were placed in the prone position. The stones were fragmented using ballistic lithotripter. The outcome was determined immediately after operation through plain radiography of the kidneys, ureters, and bladder and sonography. Various patients and stones characteristics, including perioperative outcomes and complications were evaluated. SPSS version 16 (SPSS, Chicago, IL, USA) was used for data analysis. Results: The mean age of the patients was 57.9 ± 10.5 years, and their body mass index was 26.0 ± 3.8 kg/m[2]. The mean stone size was 50.3 ± 19 mm. The average operative time was 107.7 ± 41.8 min, and the stone-free rate (SFR) was 54%. The mean postoperative hospital stay was 3.5 ± 1.9 days. The mean hemoglobin decrease was 0.16 ± 0.88 g/dL. None of our patients had organ trauma or any other significant complication. Twenty-one patients had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. The total SFR with an auxiliary procedure was 80%. Blood transfusions were needed in one patient. The average stone size was 46 ± 18 mm in the stone-free group and 55 ± 20 mm in patients without stone-free status, which was statistically significant (P = 0.027). Conclusion: Tubeless mini-PCNL was thus found to be safe and effective, even in patients with renal and upper ureteral stones ≥3 cm. Studies with a larger cohort may be required to finally validate this technique.