mini-PCNL Group Research Articles

Clinical application of dedicated ultrasound guided standard channel combined with the one-stage mini-PCNL in the treatment of staghorn nephrolithiasis

Objective To compare the efficacy and safety of standard access combined with minimally access percutaneous nephrolithotomy(mini-PCNL) and one-stage multi-channel mini-PCNL in the treatment of staghorn nephrolithiasis. Methods From August 2015 to December 2017, we prospectively collected 86 cases of the staghorn nephrolithiasis treated by multi-channel percutaneous nephrolithotomy underwent dedicated ultrasound guided.All patients were randomly divided into two groups[group of the standard channel combined with the one-stage mini-PCNL(40 cases), mini-PCNL group(46 cases)]. The operative time, number of channels, stone clearance rate, hemoglobin decline, adjuvant therapy and complication rate were summarized. Results Eighty-six patients were successfully established a multichannel, and the success of gravel stone.There was no significant difference in sex, age, stone load and preoperative complications between the two groups (P>0.05). The operation time of the combined channel group was(68.23±11.06)min, the mini-PCNL group was (82.83±9.09)min (P 0.05). The hospitalization days were(6.00±1.59) day and (7.89±2.11)day (P<0.01). The postoperative fever rate was 5.00% and 19.57%, respectively (P<0.05). There was no significant difference in the number of auxiliary treatment of one-stage postoperative, the number of channels and the removal rate of stone. Conclusions A multi-channel PCNL technique is used to treat the staghorn nephrolithotomy under the guidance of special urology ultrasound probe guide, puncture path the kidney dome, the group of standard channel combined with the one-stage had shorter time in operation and hospitalization, with lower intraoperative renal pelvic pressure, increases high the rate of the one-stage removal of stones, doesn't increase the number of channels and complications.So it is safe and reliable, worthy of clinical use. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Ultrasonography

Miniaturised percutaneous nephrolithotomy versus flexible ureteropyeloscopy: a systematic review and meta-analysis comparing clinical efficacy and safety profile.

This study aims to comparatively evaluate clinical outcomes of mini-PCNL and FURS for treating urinary tract calculi in a single session. A systematic search using electronic databases was performed for studies comparing mini-PCNL and FURS for the treatment of urinary tract calculi. The primary outcome measurements were stone-free rates (SFRs) and complication rates for both techniques. Secondary outcome measurements were to compare patient demographics, operative duration, and inpatient stay. Meta-analysis was performed with Review Manager version 5.3 software. Sixteen studies on 1598 patients (n=877 for mini-PCNL and n=721 for FURS) met inclusion criteria. Demographics including age (p=0.26), body mass index (BMI) (p=0.51), and gender ratio (p=0.6), were similar in both groups. Overall, SFR was significantly greater in the mini-PCNL group compared to the FURS group (n=763/877, 89.3±8.4% versus n=559/721, 80.1±13.3% [OR 2.01; 95% CI 1.53-2.64; p<0.01]). Duration of inpatient stay was significantly greater in the mini-PCNL group compared to the FURS group (n=877, 4±1.6days versus n=721, 2.5±2.2days, respectively [WMD: 1.77; 95% CI 1.16-2.38, p<0.01]. Overall complication rates were not significantly different between mini-PCNL and FURS (n=171/877, 19.5±19.1% versus n=112/721, 15.5±18.9%, respectively [OR 1.43; 95% CI 0.85-2.4, p=0.18]). Mini-PCNL is associated with greater SFRs and longer inpatient stay compared to FURS. Complication rates were similar for both techniques. The advantages and disadvantages of both technologies should be familiar to urologists and conveyed to patients prior to urological intervention for nephrolithiasis.

Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study.

The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL). A total of 108 patients younger than 12years of age with 1-2cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma. The stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P=0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P=0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P=0.484). According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

Use of a Novel Flexible Mini-nephroscope in Minimally Invasive Percutaneous Nephrolithotomy

To assess the feasibility and safety of a novel flexible mini-nephroscope in minimally invasive percutaneous nephrolithotomy (PCNL). Presumably, limiting the size and number of tracts during PCNL has the potential of decreasing the morbidity of the procedure. We present our experience with this new technique. A retrospective analysis of patients with multiple kidney stones treated with mini-PCNL combined with a novel flexible mini-nephroscope was performed. Minimally invasive PCNL was done with rigid 12 F MIP-M nephroscope, followed by flexible mini-nephroscopy for smaller stones in other inaccessible calyces. Record was made of the operating time, stone-free rates, postoperative pain, morbidity, hospital stay, time to recovery, complication rates, and ancillary procedures. Matched-pair analysis was done with cases operated by flexible ureteroscopy performed with Flex X-2 or Flex X-c scope. Twenty-five patients in the study group were matched with 25 cases from the flexible ureteroscopy group. Both groups were comparable in terms of age, laterality, and mean composite stone burden. The mean operating time was 40.1 ± 10.6 minutes in the mini-PCNL group and 51.2 ± 8.8 minutes in the flexible ureteroscopy group. Mean hospital stay was similar in both groups. The primary stone clearance rate of 92% (23 of 25) in the mini-PCNL group was better than the clearance rate of 80% (20 of 25) in the flexible ureteroscopy group. Eight percent in the mini-PCNL group required ancillary procedures as compared with 20% of cases in the flexible ureteroscopy group. Postoperative pain and analgesia requirement in these patients was minimal. There were no significant complications. Flexible mini-nephroscope is an effective adjuvant to minimally invasive PCNL in achieving high clearance rate with minimum morbidity.

PD18-05 COMPARATIVE OUTCOMES OF CONVENTIONAL PCNL AND MINIATURIZED PCNL IN THE TREATMENT OF KIDNEY STONES

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2016PD18-05 COMPARATIVE OUTCOMES OF CONVENTIONAL PCNL AND MINIATURIZED PCNL IN THE TREATMENT OF KIDNEY STONES Jessica Lange and Jorge Gutierrez-Aceves Jessica LangeJessica Lange More articles by this author and Jorge Gutierrez-AcevesJorge Gutierrez-Aceves More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrostolithotomy (PCNL) is the preferred method to treat large renal stones. PCNL has excellent stone free rates, but it known to have increased blood loss, postoperative pain, and hospital stay relative to other treatment modalities. In recent years, techniques used to create a smaller percutaneous tract have gained interest. Miniaturized PCNL (mini-PCNL) requires dilation of a smaller percutaneous tract, potentially leading to less blood loss, less postoperative pain, and shortened hospital stay. In this study, we compare efficacy and outcomes of conventional and mini-PCNL at our institution. METHODS The outcomes of 29 consecutive mini-PCNLs were compared to 27 conventional PCNLs performed by a single surgeon at our institution. Study inclusion criteria included age ≥ 18 years, BMI 18-40 kg/m2, and first look PCNL for stones 1-3.5 cm in greatest dimension. Conventional PCNL required percutaneous tract dilation to 30 French and stone fragmentation using pneumatic and/or ultrasonic lithotrites and/or holmium:YAG laser. Mini-PCNL was performed using the minimally invasive percutaneous access set (Storz®), dilating the tract to 16 French, and using holmium:YAG laser for stone fragmentation. RESULTS There were no significant differences between the groups in baseline age (PCNL 55.5 ± 15.3 years, mini-PCNL 53.0 ± 15.8 years) or BMI (PCNL 28.5 ± 5.7, mini-PCNL 29.0 ± 6.0 kg/m2). There was no significant difference in preoperative stone burden between groups though the mini-PCNL mean stone burden was slightly smaller. Seventeen patients in the conventional PCNL group and 19 patients in the mini-PCNL group were stone free (defined as residual stone fragments < 2 mm on postoperative CT scan) after one procedure. There was no significant difference in residual stone burden, total operative time, or postoperative analgesic use between groups. There was a significant difference in blood loss, but no patients required blood transfusion. CONCLUSIONS Both conventional PCNL and mini-PCNL are effective methods of removing renal stones 1-3.5 cm. There appears to be no difference in residual stone volume, postoperative analgesic use, or operative time between the two techniques. Blood loss was less in the mini-PCNL group though this may have little clinical significance. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e405 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jessica Lange More articles by this author Jorge Gutierrez-Aceves More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Study on tubeless mini-percutaneous nephrolithotomy in treatment of the upper ureteral calculi

Objective To investigate the feasibility and clinical effect of the tubeless mini-percutaneous nephrolithotomy (PCNL) in treatment of upper ureteral calculi. Methods From March 2014 to March 2015, all the patients with upper ureteral calculi except for those with severe infection, pyonephrosis or renal cortex less than 5 mm were randomized into two groups, the standard PCNL group (24 F nephrostomy tube) and the mini-PCNL group (18 F nephrostomy tube). After PCNL, all the patients received ultrasound examination to check residual stones, perforation and urine leakage. DJ tube was placed and the channel of PCNL was packed with hemostatic sponge without nephrostomy tube. There were 26 patients in standard group and 28 in mini-group. The operation time, postoperative hemoglobin change, postoperative visual analogue pain score (VAS), the time when urine turned clean, postoperative urinary extravasation, hydrothorax, fever and the stone-free rate were compared between two groups. Particularly, these data were compared in those aged>65 years. Results The operation time in the standard PCNL and the mini-PCNL group was (58.3±21.8) and (86.4±23.3) minutes respectively, and had a significant difference (t=10.836, P 0.05). No significant difference were found between two groups (all P>0.05). There was one patient who got fever more than 38.5℃ in the standard group and 2 cases in the mini-group. Each group had 1 slight hydrothorax, and no blood infusion and perinephric urinary extravasation were found. The application of packing hemostatic sponge in the nephrostomy channel was feasible and suitable for both the standard and tubeless mini-PCNL groups. Conclusions The application of packing hemostatic sponge in the nephrostomy channel is feasible and suitable in both the standard and tubeless mini-PCNL. It is safe for the treatment of renal and ureteral calculi, and it can decrease the hemorrhage and urine leakage, which works for the elderly patients too. Key words: Percutaneous nephrolithotomy; Ureteral calculi

Mini-percutaneous Nephrolithotomy vs Retrograde Intrarenal Surgery for Renal Stones Larger Than 10 mm: A Prospective Randomized Controlled Trial

To compare miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the management of renal stones >10 mm in a single session. Seventy patients presenting with renal stones >10 mm were randomized to a mini-PCNL or an RIRS group in a ratio of 1:1. Randomization was performed by a biostatistician and opened to the surgeon at the time of the patient's admission on the day before surgery. Patient and stone characteristics, perioperative outcomes, and complications were compared between the 2 groups. The primary end point of "stone-free" which was defined as no residual stone or stones <2 mm on computed tomography within 3 months postoperatively. Thirty-five patients (mini-PCNL) and 33 (RIRS) were included in the final analysis. Mini-PCNL and RIRS had a stone-free rate of 85.7% and 97.0%, respectively (P = .199). Operation time (P = .148), hemoglobin decline (P = .323), and hospital stay (P = .728) were similar between the 2 groups. Pain visual analog score at 1 hour postoperatively (P = .029) and analgesic requirement (P = .050) were higher in the RIRS group. Two patients in the mini-PCNL group and 1 in the RIRS group had minor pelvic or ureter perforation. One patient in each of the 2 groups had hypertension and urinary tract infection. Mini-PCNL and RIRS are safe and feasible surgical options to manage renal stones >10 mm. RIRS produced a slightly higher stone-free rate, but more immediate postoperative pain and higher analgesic requirement compared with mini-PCNL.

Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy

To provide appropriate evidence for treatment planning of patients with an impacted proximal ureteral stones ≥1.5 cm in size, by analyzing the therapeutic outcomes for those undergoing minimally invasive percutaneous antegrade ureterolithotripsy and retrograde ureterolithotripsy. From September 2010 to November 2011, eligible patients with impacted proximal ureteral stones ≥1.5 cm in size referred to our institute were considered for this study. The closed envelope method was used to randomize the enrolled patients to mini-PCNL (30) or retrograde ureterolithotripsy (29). The efficiency quotient (EQ) was calculated to specifically address the efficiency for both the techniques. All preoperative and postoperative data for both groups were recorded. The initial stone-free rate was 93.3% in the mini-PCNL group and 41.4% in the URSL group (p < 0.001). However, the overall stone-free rate at the 1-month follow-up visit after initial treatment was 100% in the mini-PCNL group and 89.7% in the URSL group (p = 0.07). The EQs for the mini-PCNL and URSL groups were 0.83 and 0.50, respectively. Our study shows that mini-PCNL removal of large impacted proximal ureteral calculi can achieve higher stone-free rates and safe.

Percutaneous nephrolithotomy of staghorn calculi in patients by mini-tract and standard-tract

To compare the outcome of mini-tract vs standard-tract percutaneous nephrolithotomy (PCNL) in staghorn calculi. Between May 2009 and May 2011, 122 patients with renal staghorn calculi were treated by PCNL. Fifty-six patients underwent mini-PCNL and the others underwent standard-PCNL. The therapeutic effect and complication of the 2 groups were compared. The two groups had comparable demographic conditions. Although the operation time was significantly longer in mini-PCNL group [(126±24.5) min vs (98±18.9) min], there was no striking difference in hospital stay [(5.7±1.3) d vs (5.3±1.1) d], hemoglobin drop [(9.5±3.2) g/L vs (10.5±3.3) g/L], stone-free state before charge (91.1% vs 89.4%) and complications. The efficacy and safety of mini-PCNL and standard-PCNL are not significantly different.