Safety Of Mini-percutaneous Nephrolithotomy Research Articles

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience.

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

Mini-percutaneous nephrolithotomy versus Standard percutaneous nephrolithotomy: outcome and complications

BackgroundRenal stones are a prevalent urological disorder with various treatment options, including minimally invasive techniques such as Standard-PCNL (S-PCNL) and Mini-percutaneous nephrolithotomy (M-PCNL). This study aims to compare the efficacy and safety outcomes of M-PCNL and S-PCNL for managing renal calculi.MethodsThis randomized study enrolled 60 patients with renal stones, comparing the efficacy and safety of M-PCNL (Group A) and S-PCNL (Group B) procedures. Preoperative assessments, surgical procedures, and postoperative care were conducted, and outcomes such as operating time, stone clearance, analgesic requirement, and hospital stay were evaluated. Data analysis was performed using SPSS software, with comparisons between groups conducted using the Chi-square test and Student t test.ResultsM-PCNL had a longer operation time (133.73 ± 29.18 min) than S-PCNL (48.6 ± 17.88 min, p = 0.009) but a lower mean drop in hemoglobin levels (0.14 ± 0.01 g/dL vs. 0.82 ± 0.05 g/dL, p = 0.032). The success rates (stone-free rate) were significantly different, with 100% in the M-PCNL group and 86.7% in the S-PCNL group (p = 0.040). Complications were generally fewer in the M-PCNL group, including postoperative fever in 2 cases (M-PCNL) vs. 8 cases (S-PCNL) and mild collection in 4 cases (M-PCNL) vs. 26 cases (S-PCNL).ConclusionsM-PCNL is an effective and safer method for managing renal calculi smaller than 3 cm, offering a higher stone-free rate, lower postoperative pain, and shorter hospital stays compared to S-PCNL. Despite longer operation times due to stone fragmentation, M-PCNL has fewer complications, including lower bleeding rates, hemoglobin drop, and leakage, and can be performed using an ureteroscope when a miniperc scope is unavailable.

Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It?

Purpose: To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. Patients and Methods: From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. Results: A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Conclusions: Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan.

To assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1-2 cm in size in infants less than one year. This descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications. A total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5-12 month). The mean stone size was 15.8 + 2.7 (10-21) mm in length and 12.3 + 2.2 (8-17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40-70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9-2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients. Mini-PCNL is a safe and effective treatment for renal stones in infants measuring 1-2 cm with high SFR and an acceptable complication rate.

Comparison between mini-Percutaneous Nephrolithotomy (PCNL) and standard PCNL in pediatric patients: a systematic review and meta-analysis

Background: We conducted a systematic review and meta-analysis to determine the efficacy and safety of mini-Percutaneous Nephrolithotomy (PCNL) compared to standard PCNL in children with nephrolithiasis. Clinical trials and observational studies comparing standard PCNL and mini-PCNL in pediatric patients were identified from electronic databases in November 2021. Method: Studies were extracted for author, year, location, design, subjects’ age, sample size, objective, primary endpoint, level of evidence, and results (stone-free rates and complications). Results were subjected to qualitative analysis using the synthesis method. Adequate results were extracted and analyzed quantitatively using the fixed-effect model on homogenous data or the random-effect model on heterogeneous data for meta-analysis. Outcome variables are shown as odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed with Review Manager version 5.4. Result: We reported that stone-free rate and residual stone vary between two studies with contrary results. However, our quantitative analysis showed an insignificant difference between both groups of stone-free rate (OR 0.75; 95% CI 0.22-2.54) and residual stone (OR 1.27; 95% CI 0.55-2.91). Complications rates were insignificantly different between mini-PCNL group and PCNL group in two studies in Clavien 1 (OR 0.65; 95% CI 0.27-1.54) and Clavien 2 grade (OR 0.48; 95% CI 0.19-1.22). In addition, pooled analysis of both complication grades was also insignificant in the difference between groups (OR 0.56; 95% CI 0.30-1.06). Conclusion: The efficacy and safety of mini PCNL were neither superior nor inferior compared to standard PCNL in managing nephrolithiasis in pediatric patients. Moreover, mini PCNL was considered better regarding post-operative pain and tract infection; thus, mini PCNL could be considered a treatment option for pediatric patients with nephrolithiasis.

Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis.

ABSTRACTBackground The purpose is to compare the efficacy and safety of mini percutaneous nephrolithotomy (mini-PCNL) versus standard percutaneous nephrolithotomy (standard-PCNL) in patients with renal stones >2cm.Materials and Methods A systematic literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library databases to identify relevant studies before March 8, 2021. Stone-free rate (SFR), operation time, fever rate, hemoglobin drop, blood transfusion rate, and hospitalization time were used as outcomes to compare mini-PCNL and standard-PCNL. The meta-analysis was performed using the Review Manager version 5.4.Results Seven randomized controlled trials were included in our meta-analysis, involving 1407 mini-PCNL cases and 1436 standard-PCNL cases. Our results reveal that, for renal stones >2cm, mini-PCNL has a similar SFR (risk ratio (RR)=1.01, 95% confidence interval (CI): 0.98 to 1.04, p=0.57) and fever rate (RR=1.22, 95% CI: 0.97-1.51, p=0.08). Standard-PCNL was associated with a significantly shorter operating time (weighted mean difference (WMD)=8.23, 95% CI: 3.44 to 13.01, p <0.01) and a longer hospitalization time (WMD=-20.05, 95% CI: -29.28 to -10.81, p <0.01) than mini-PCNL. Subgroup analysis showed hemoglobin drop and blood transfusion for 30F standard-PCNL were more common than mini-PCNL (WMD=-0.95, 95% CI: -1.40 to -0.50, p <0.01; RR=0.20, 95% CI: 0.07 to 0.58, p <0.01).Conclusion In the treatment of >2cm renal stones, mini-PCNL should be considered an effective and reliable alternative to standard-PCNL (30F). It achieves a comparable SFR to standard-PCNL, but with less blood loss, lower transfusion rate, and shorter hospitalization. However, the mini-PCNL does not show a significant advantage over the 24F standard-PCNL. On the contrary, this procedure takes a longer operation time.Trial registration This meta-analysis was reported consistent with the PRISMA statement and was registered on PROSPERO, with registration number 2021CRD42021234893.

Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis.&#x0D; Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay.&#x0D; Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p&lt;0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p&lt;0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p&lt;0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p&lt;0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р&lt;0.001.&#x0D; Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

Comparison of mini-PCNL and retrograde intrarenal surgery in the treatment of kidney stone over 50 years old patients.

Mini-Percutaneous Nephrolithotomy (M-PCNL) and Retrograde Intrarenal Surgery (RIRS) are commonly used methods in treatment of kidney stones. The aim of our study is to compare the efficacy and safety of M-PCNL and RIRS in kidney stone treatment over 50 years old patients. A total of 125 patients, 65 of whom had RIRS, and 60 of whom had M-PCNL, were included in the study. Age, gender, BMI (Body-Mass Index), ASA (American Society of Anesthesiology) scores of the patients; stone size, stone location, operation side, ESWL history, HU (Hounsfield Unit) values, hospital stay durations, SFR, complication rates according to Clavien modification system, postoperative hemoglobin loss, postoperative transfusion rates, and patients who needed a secondary operation were recorded. SFR values were calculated in the postoperative third and sixth months. The data between the two groups had similar characteristics in terms of age, gender, BMI, HU, stone size, operation side, stone location, ESWL history, operation time, postoperative transfusion rate, postoperative Clavien complications (p > 0.05). When the ASA categories were evaluated, the mean ASA scores, ASA I, and ASA II data had similar characteristics in both groups (p > 0.05). When the ASA 3 scores were evaluated, the number of ASA III patients in the RIRS group was statistically significantly higher (p < 0.05). When hospital stay duration and postoperative hemoglobin loss were examined, RIRS group was found to be advantageous (p < 0.05). Postoperative third month SFR and Postoperative sixth month values were statistically significantly higher in M-PCNL group (p < 0.05). M-PCNL and RIRS are methods that can be used safely and effectively over 50 years old patients in kidney stone surgery. M-PCNL has been found to be more advantageous in terms of SFR rates and as it requires less secondary intervention. RIRS is advantageous in terms of short hospital stay, postoperative hemoglobin loss, and applicability to patients who are not suitable for the prone position.

Nomograms predicting the outcomes of endoscopic treatments for pediatric upper urinary tract calculi.

To demonstrate the efficacy and safety of mini-percutaneous nephrolithotomy, micro-percutaneous nephrolithotomy, and flexible ureteroscopy for pediatric upper urinary tract calculi and to develop nomograms predicting surgical outcomes. A prospectively managed database containing children who were diagnosed with upper urinary tract calculi and treated with mini-percutaneous nephrolithotomy, micro-percutaneous nephrolithotomy, and flexible ureteroscopy between June 2014 and April 2019 was analysed. Patient demographics, intraoperative data, stone characteristics, stone-free rate, and complication rate were analysed and compared. Nomograms predicting the postoperative stone-free rate and complication rate were established based on predictors, and internal validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. Forty-three children underwent mini-percutaneous nephrolithotomy on 56 sides in 47 operations, 30 children underwent micro-percutaneous nephrolithotomy on 30 sides in 30 operations, and 275 children underwent flexible ureteroscopy on 320 sides in 288 operations. The stone-free rates were 88.5% (282/320) for flexible ureteroscopy, 89.3% (50/56) for mini-percutaneous nephrolithotomy, and 90.0% (27/30) for micro-percutaneous nephrolithotomy (P=0.94). And the complication rates were 19.8% (57/288), 36.2% (17/47), and 33.3% (10/30), respectively (P=0.02). Nomograms based on stone characteristics, operation duration, and the physical condition of the child were shown to have good discrimination and calibration. The area under the curve of the models was 81% for stone-free rate and 73% for complication rate. The calibration curves showed that the nomogram might underestimate the probability of stone-free rate when the threshold was below 82% and might overestimate the risk of complication rate when the threshold was over 25%. The decision curves demonstrated that the Capital Medical University nomograms improved clinical risk prediction against threshold probabilities of stone-free rate ≤20% and complication rate ≤10%. Both the percutaneous nephrolithotomy and flexible ureteroscopy procedures could have acceptable stone-free rates when treating pediatric stones. The Capital Medical University nomograms performed well in helping to predict stone-free and complication rates.

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.

Clinical analysis of mini-percutaneous nephrolithotomy in 39 infants with upper urolithiasis in Hotan region, Xinjiang Uyger Autonomous Region

Objective To evaluate the effectiveness and safety of mini-percutaneous nephrolithotomy in treating infant upper urolithiasis. Methods Retrospective analysis of 39 cases of infant upper urolithiasis treated with mini-percutaneous nephrolithotomy between March 2015 to January 2016 in Hotan Region People′s Hospital was performed, with the age of(1.8±1.2) years(6 months to 3 years old), including 21 male and 18 female.Exclusion of inherent anatomical abnormalities of urinary tract was performed by pre-operation image screening.A total of 46 renal were treated with mini-percutaneous nephrolithotomy, including 7 cases of bilateral urolithiasis.Urinary tract radiograph or ultrasonagraphy, operation time, hemoglobin(Hb) decrease, electrolyte changes and stone clearance were recorded after operation. Results All scheduled mPCNLs were performed snccessfully.The stone burden was(3.1±0.9) cm(ranging from 2.0 to 4.0 cm) in 46 renal units with a the pre-operative Hb(114.0±22.1) g/L (76 -137 g/L), including 3 cases Hb less than 80 g/L and 3 cases of serum albumin less than 25 g/L, and the weight of 14 patients was less than the standard weight.Access was gained from medium posterior calyx in 39 cases and upper calyx in 6 cases, and double access pathway was performed in 1 case who with parallel calyx urolithiasis.The operation time was 37-65 min, and the mean operation time was 52 min.Post-operative stone clearance was 78.26%.There were 3 cases(6.25%) grade Ⅰ and 5 cases(10.87%) grade Ⅱ complications including 3 cases(6.52%) with infectious complication and 2 cases(14.35%) with blood transfusion.No grade Ⅲ complications were observed. Conclusions Single mPCNL is recommended as a standard treatment for infant upper uroliathiasis with more carefully and systematic pre-operation evaluation due to their poor tolerance. Key words: Lithology; Urinary system; Percutaneous nephrolithotomy; Infant

Neodymium:Yttrium Aluminum Garnet laser for mini-percutaneous treatment of upper urinary tract stones

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium: Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase: lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase II lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an average time of 100+/-15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65+/-11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5%). All ureteral stones were completely removed in 15 cases (100%). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.