Efficacy Of Mini-percutaneous Nephrolithotomy Research Articles

Evaluation of the Efficacy of Mini Percutaneous Nephrolithotomy in Comparison with Standard Percutaneous Nephrolithotomy for the Management of Large Renal Stones, a Randomized Controlled Clinical Trial

Abstract Background Management of renal calculi targets complete clearance without any residual fragments, along with pain relief and eradication of the causative micro- organisms. Percutaneous nephrolithotomy (PNL) is currently the standard treatment option for patients with complex and large renal stones. However, innovations in instruments and techniques have resulted in “miniperc”, which was found to be safe and effective. Aim and Objectives to compare between mini PNL and the standard PNL in management of renal stones (20-40 mm) regarding operative time, fluoroscopy time, blood loss, stone free rate, and postoperative complications according to modified Clavein system. Subjects and Methods This prospective randomized comparative study was carried out at Urology department Ain Shams University hospitals, from 2019 to 2022 on 93 patients coming for renal stone management. Patients were divided into 2 groups: Group A included 44 patients who underwent standard PNL, whereas Group B included 49 patients who underwent mini PNL. Result The standard PNL yielded shorter operating time 70.1 ± 13.9 min vs 96.4 ±14.3 min,p <0.001) Patients in the standard PNL group also had longer hospitalization time, nephrostomy time and catheterization time(4 vs 3 days, 36 vs 24 hours and 5 vs 4 days respectively, p < 0.001). The mean drop in hemoglobin level that necessitated blood transfusion was significantly lower in the mini PNL group (0.7 vs 1.6 gm/dl, p < 0.0001). Although the stone-free rate was higher in the standard PNL group, but this was statistically insignificant (79.5 vs 61.2%, p = 0.054) According to modified Clavien–Dindo classification, no statistical difference was detected between the 2 groups in terms of complication rates The postoperative pain and the need for postoperative analgesia were significantly more in standard PNL patients. Visual Analogue Score (VAS) was 7.4 and 5.2 in standard PNL and mini PNL respectively. Conclusion We compared the standard PNL and mini PNL regarding the safety and efficacy in management of large renal stones. Standard PNL achieved higher stone free rate and shorter operative time while mini PNL has the advantage of shorter hospitalization time and low incidence of postoperative complications and pain.

Safety and Efficacy of Mini Percutaneous Nephrolithotomy in Paediatric age Patients: Paving the Way Towards Minimally Invasive Techniques in Resources Limited Areas

Objectives: To assess the safety and effectiveness of mini-percutaneous nephrolithotomy (PCNL) in paediatric age patients. Materials and Methods: This descriptive case series study was conducted in the Department of Paediatric Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan from June 2017 to June 2020. Children < 14 years, diagnosed with renal stone > 1cm in size on non-contrast CT of Kidney Ureter and Urinary Bladder (KUB) and having negative urine culture were enrolled in the study. Patients having abnormal renal functions and bleeding diathesis were omitted from the study. Informed written consent was taken from the parents of all the children. Children with no stone fragments in the kidney or ipsilateral ureter on non-contrast CT KUB at one month were labelled as stone free. Results: A total of 213 children who underwent mini-PCNL were analyzed. 130 (61.03%) of the stones were 10-15 mm and 83 (38.97%) were > 15 mm in size. The mean operation time was 56.02 + 7.82 (40-81) minutes .The mean hospital stay was 2.22 + 0.67 (2-7) days. The mean decrease in haemoglobin was 1.30 + 0.67 (0.2-4.0) gm/dL. No major intraoperative complication was observed. 24 (11.27%) of the patients developed post-operative complications including 10.33 % minor and 0.94 % major complications which were statistically insignificant. As a monotherapy mini-PCNL achieved complete stone clearance at one month in 191 (89.67%) of the patients. Retreatment was required in 22 (10.33%) of the patients including extracorporeal shock wave lithotripsy (ESWL) in 7 (3.29%), ureteroscopy (URS) in 10 (4.69%) and Re-PCNL in 5 (2.35%) patients. Conclusion: This study concludes that mini-PCNL in a paediatric population is safe and effective for renal stones > 10 mm with acceptable stone clearance and complications. Keywords: Kidney calculi, Pediatrics, Percutaneous, Children, Urolithiasis

Flexible ureterorenoscopy (RIRS) vs. Mini- percutaneous nephrolithotomy (MINI-PCNL) for renal stones 20\u201330\xa0mm a prospective randomized study

BackgroundTo evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm.MethodsA prospective randomized study of 70 patients who presented to the urology department with calyceal or renal pelvic stone of 20–30 mm between September 2017 and September 2019. Patients were randomly divided into two groups, Group A (Mini PCNL) consists of 35 patients who were treated with mini PCNL and Group B (RIRS) consists of 35 patients who were Achieving success of the technique was considered when the patient is stone-free or has radiologically insignificant residual fragments < 4 mm.ResultsThe demographic data in this study were comparable in both groups. The stone size was 20.43 ± 2.2 mm in group A & 20.5 ± 2.1 in group B, with no statistical significance. Meanwhile, the operative time in group A was 59.71 ± 19.44 min and in group B was 80.43 ± 14.79 min with statistical significance difference (p value < 0.001), while Fluoroscopy time had a mean of 8.11 ± 2.05 min in group A & 5.8 ± 1.98 min in group B with statistically significant diffrence (p value < 0.001). The stone free rate (SFR) was 88.6% in mini PCNL and 82.9% in RIRS with no statistically significant difference (p value: 0.5).ConclusionRIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini-PCNL has more operative and postoperative complications. A multicenter studies with larger numbers of patients will be more effective to confirm these results.

The safety and efficacy of mini-percutaneous nephrolithotomy vs. retrograde intrarenal surgery for treatment of renal lithiasis in pelvic ectopic kidney: an exploratory pilot study.

BackgroundTo compare the safety and efficacy of mini-percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of renal lithiasis in patients with pelvic ectopic kidney.MethodsFrom January 2015 to October 2017, mini-PCNL and RIRS were performed in ten patients diagnosed with lithiasis in pelvic ectopic kidneys, including three cases under laparoscopy-assisted mini-PCNL. Patient demographics and perioperative characteristics (age, gender, BMI, side of pelvic kidney, stone size, stone number, stone location, special medical history, and ASA physical status classification), and operative and post-operative related details (operation time, hospital stay, blood loss, VAS, analgesic requirement, complications, and stone free outcome) were reviewed.ResultsAlthough the mean operation time of mini-PCNL (71.3 min) was shorter than RIRS (85.3 min), the mean operation time of laparoscopy assisted mini-PCNL (92 min) was longer than patients without laparoscopy-assisted mini-PCNL (55.8 min). However, the use of mini-PCNL allowed for larger lithiasis to be dealt with (1.9 cm in laparoscopy assisted mini-PCNL and 2.4 cm in mini-PCNL without laparoscopy-assist) compared with RIRS (1.2 cm). In addition, although the mean hospital-stay time, blood loss, and analgesic requirement of patients undergoing RIRS were less than those receiving mini-PCNL, the success rate of RIRS was only 50% (3/6) in comparison to 100% (7/7) for mini-PCNL. Except for pain and urinary tract infection after the operation, there were no significant intraoperative and postoperative complications, and no residual lithiasis were seen in any patient.ConclusionsAlthough RIRS was less time-consuming and invasive, mini-PCNL can deal with the bigger lithiasis and more complex situations with a higher success rate. Both mini-PCNL and RIRS are feasible and safe treatments for pelvic ectopic kidney lithiasis with each carrying unique advantages. Hence in practice, an appropriate individualized treatment should be selected depending on patient characteristics.

Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study

BackgroundTo evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL.MethodsIn this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained.ResultsOut of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended.ConclusionsWe can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.

Does body mass index impact the efficacy and complication rate of mini-percutaneous nephrolithotomy?

Aim: This was a retrospective cohort study exploring the efficacy of mini-percutaneous nephrolithotomy in obese patients and whether stone clearance, complication rate and length of stay is impacted by an increasing body mass index. Method: Data was collected retrospectively for all mini-percutaneous nephrolithotomies performed at a single centre over a 21-month period commencing March 2017. The primary outcomes included length of stay, stone clearance rates and complications. Results: Fifty-eight percutaneous nephrolithotomies were undertaken during the study period and of these cases 81% of patients had a body mass index of 25 or greater. The stone clearance rate was 83%. However, severely obese patients were noted to have a lower stone clearance rate. No complications occurred in the normal body mass index cohort. However, there was no difference in the complication rate for the remaining groups. Post-operative stay was approximately 3 days. Conclusion: This study demonstrates that supine mini-percutaneous nephrolithotomies are a safe option in obese patients with no increased risk of serious complication. Whilst stone clearance rates were lower in the severely obese category, clearance was complete in the majority of cases. Level of evidence: 3

The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy.&#x0D; Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value &lt;0.05 was considered significant.&#x0D; Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin.&#x0D; Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.

Safety and efficacy of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones

Background: To evaluate the efficacy and safety of Mini-Percutaneous Nephrolithotomy (PCNL) in the treatment of large (≥15mm) impacted proximal ureteral stones.Methods: This was a prospective observational study and was conducted in the Postgraduate Department of Surgery, Govt. Medical College, Srinagar. A total of 60 patients were included in this study.Results: The mean age (in years) of patients was 38.5±9.31 and range 22-58, the male female ratio was 40:20, the disease laterality (right: left) was 48:12, the mean stone size (in mms) was 17.6±2.11. All the patients were having hydronephrotic kidneys, however, all the renal units were functional. The mean operative time (in minutes) was 62±9.62. The overall success rate was 96.7% after one month of follow-up the stone free rate was 96.7% while as the stone free rate on discharge was 86.7%. The mean hospital stays (in days) was 2.8±1.08. The overall complication rate in this study was 15 patients (25%) which include post-operative fever in 5 patients (8.33%), prolonged hematuria in 4 patients (6.67%), residual stone/disease after 4weeks of follow-up was seen in 2 patients (3.33%) and in 4 patients (6.67%) thoracic complication was seen. However, no ureteral injury, hollow visceral or pelvic perforation was noted. The post-operative analgesic requirement was 100±40.45mgs of Inj. Tramadol. The need of auxiliary procedures was required in 3.3% of patients.Conclusions: Mini-PCNL is both safe as well as an effective therapy for large impacted proximal ureteral stones with a higher success, stone clearance rate and with acceptable complications.

Safety and efficacy of Mini-Percutaneous Nephrolithotomy in the treatment of large impacted Proximal Ureteral Stones

The management of large, impacted upper ureteric calculi remains challenging for urologists. Various treatment options include extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URSL), percutaneous nephrolithotripsy (PCNL), laparoscopic and open ureterolithotomy. ESWL has poor overall success rate in the treatment of large stones with a significant possibility of residual fragments.

Safety and efficacy of mini-percutaneous nephrolithotomy(PCNL) in renal or upper ureteric stone &gt;1cm

Abstract available on the PDF.

1131 To evaluate efficacy of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for stones 10-30 mm size

1131 To evaluate efficacy of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for stones 10-30 mm size