Standard Percutaneous Nephrolithotomy Group 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.

Perioperative and long-term results of ultrasonography-guided single- and multiple-tract percutaneous nephrolithotomy for staghorn calculi.

It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy (M-PCNL) has a similar stone free rate (SFR) as standard percutaneous nephrolithotomy (S-PCNL). As a result, M-PCNL was also recommended as a treatment option for staghorn calculi. To examine the perioperative and long-term results of ultrasonography-guided single- and M-PCNL. This was a retrospective cohort study. Between March 2021 and January 2022, the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy. The primary outcomes were complication rate and SFR, and the characteristics of patients, operative parameters, laboratory measurements were also collected. In total, 345 patients were enrolled in the study (186 in the S-PCNL group and 159 in the M-PCNL group). The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group (P = 0.033). Moreover, the incidence rates of hydrothorax (P = 0.03) and postoperative infection (P = 0.012) were higher in the M-PCNL group than in the S-PCNL group. Logistic regression analysis demonstrated that post-operative white blood cell count (OR = 2.57, 95%CI: 1.90-3.47, P < 0.001) and stone size (OR = 1.59, 95%CI: 1.27-2.00, P < 0.001) were associated with a higher overall complication rate in the S-PCNL group. Body mass index (OR = 1.22, 95%CI: 1.06-1.40, P = 0.004) and stone size (OR = 1.70, 95%CI: 1.35-2.15, P < 0.001) were associated with increased overall complications in the M-PCNL group. Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.

Assessing the Efficacy of Mini-PCNL Versus Standard PCNL for Management of Staghorn Calculi &gt;2cm: A Prospective Study in Peshawar

Background: Staghorn stones pose a significant challenge in urology, given their complex nature and potential for causing substantial renal damage. Traditional management has often involved standard percutaneous nephrolithotomy (PCNL), known for its efficacy in stone clearance but also associated with considerable complication rates. Recent advancements have led to the development of mini-PCNL, aiming to reduce these complications while maintaining high stone clearance rates. Objective: This study aims to compare the efficacy, safety, and outcomes of standard and mini-PCNL in the management of staghorn stones, with a focus on complication rates, stone clearance, and hospital stay durations. Methods: A prospective study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, involving 162 patients undergoing PCNL for staghorn stones from January 2020 to December 2023. Patients were categorized into standard PCNL (n=69) and mini-PCNL (n=93) groups based on the procedural approach. Pre-operative, intra-operative, and post-operative data were collected, including patient demographics, stone size and density, operative findings, post-operative complications, and stone clearance rates. Statistical analysis was performed using SPSS version 25. Results: The mini-PCNL group demonstrated a significantly smaller average stone size (26.8 ± 5.8 mm) compared to the standard PCNL group (32.3 ± 10.3 mm, p=0.037). Single tract use was more prevalent in mini-PCNL (87.1%) than in standard PCNL (71.0%, p=0.016). Stone clearance rates were higher in the mini-PCNL group (87.1%) versus the standard group (73.9%, p=0.041). The average hospital stay was shorter for mini-PCNL patients (2.4 ± 1.0 days) compared to those undergoing standard PCNL (3.0 ± 1.1 days, p=0.030). Complications, including post-operative hematuria requiring transfusion, were more common in the standard PCNL group. Conclusion: Mini-PCNL offers a safer and more effective alternative to standard PCNL in the management of staghorn stones, with lower complication rates, higher stone clearance rates, and shorter hospital stays. These findings support the adoption of mini-PCNL as a preferred approach for managing complex renal calculi.

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

PurposeIn this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated.MethodsFrom January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups.Results146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B.ConclusionAccording to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

Comparative analysis of standard, tubeless and total tubeless percutaneous nephrolithotomy: A prospective study.

This study was done to review and compare safety, effectiveness and advantages of total tubeless percutaneous nephrolithotomy (PCNL), tubeless PCNL with standard PCNL. This prospective comparative study involving 30 patients in each total tubeless PCNL, tubeless PCNL and standard PCNL group from Feb 2021 to June 2022. Significant difference was found in mean duration of surgery (p < 0.01), mean hospital stay (p < 0.01), mean VAS post op score (p < 0.01), mean time to return to normal activity (p < 0.01) in total and tubeless PCNL group as compared with standard PCNL. While no significant difference found in mean haemoglobin drop (p = 0.1417), blood transfusion (p = 3721), incidence of urine leak (p = 0.13), need of accessory secondary procedure (p = 0.1322) and associated complications (p = 0.5939) among three groups. Study observed that total tubeless, tubeless PCNL is a safe and efficient technique. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores. Total tubeless PCNL obviates need of second procedure of removing DJ stent. Standard, tubeless and total tubeless PCNL have similar post op complication rate. Study thus concludes that total tubeless, tubeless PCNL can be used as a substitute for traditional standard PCNL.

Standard Vs Mini-Percutaneous Nephrolithotomy for Staghorn Stones

Objective: Objective of this study was to compare the effectiveness of standard and mini-percutaneous nephrolithotomy in treating staghorn stones Methodology: From July 2017 to June 2019, In Institute Of Kidney Diseases (PGMI) Hayatabad Medical Complex Peshawar a tertiary care hospital we conducted a randomized controlled trial to determine the stone-free rate for patients with staghorn stones (Total duration of the study was 2 years). The trial included 150 patients separated into two groups: one that received standard- and mini-PCNL surgeries. Each patient was randomly assigned to undergo one of the two procedures, with 50% receiving standard PCNL and the other 50% mini-PCNL. Durations of surgical procedures, length of hospital stay, complications, and pain levels were all measured during the study. Result: 150 patients with a mean age of 51.2 years (range, 18-85 years) were included in this research. 88% of the participants were men and 16% were women. Success rates for standard PCNL and mini-PCNL were 97.3% and 90.7%, respectively (p=0.04). Additionally, compared to the standard-PCNL group (105.3 minutes and 3.3 days, respectively), the mini-PCNL group had a considerably reduced mean operation time (80.2 minutes) and a shorter mean hospital stay (2.2 days) (p 0.001). Standard PCNL also had a higher overall complication rate than mini-PCNL (26% vs. 13%, p = 0.038). In addition, the mini-PCNL group had considerably less postoperative discomfort (p 0.001). Conclusion: When controlling staghorn stones, Mini-PCNL has shown to be a reliable and safe solution that offers a number of benefits over conventional Standard-PCNL. Mini-PCNL clearly outperforms standard PCNL in terms of lowering postoperative pain, hospital stays, and operating room time. As a result, Mini-PCNL is gradually becoming into the preferred operational strategy for effectively controlling staghorn stones. Keywords: Percutaneous nephrolithotomy, staghorn stones, stone-free rate, surgical time, hospital stay, complications, postoperative discomfort.

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.

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) technique has become a routine treatment for upper urinary calculi. Objectives: To describe the socio-demographic characteristics of the patients and to compare the outcome of operated patients. Materials And Methods: This was a retrospective study, of patients underwent PCNL in our Urology Center, between January 2020 and December 2022. Data of age, side, location of stone, size of stone, operating time, hospital stay, post operation pain, residual stones, fever, fistula, blood transfusion, and postoperative infection were recorded and compared between the two groups. Data were analyzed by using the SPSS version 22. Independent t-tests were used to analyze continuous variables, while for categorical variables chi-square test was used to compare two groups and a p value of less than 0.05 was determined as statistically significant. Results: 51.1% of the patients were females and 48.9% were males, (P = 0.000). The mean age was 38.1 ± 11.1 years. The highest number of patients were in the age group 30 – 39 years (40.0%), (P = 0.000). The location of stones was in pelvic (48.9%), lower calyces (30.0%) and pelvic + lower calyces (21.1%), (P = 0.000). Pain was more common as moderate in both groups PCNL (42.2%). Residual stones were (23.4%) only in standard PCNL group, (P = 0.000). Fever was in (7.8%) standard PCNL and in tubeless PCNL was in (2.2%), (p = 0.045). Blood transfusion was provided to (5%) for the standard PCNL patients and (3.3%) for tubeless PCNL patients. Patients who had standard PCNL had postoperative infectious (2.2%) was found in standard PCNL patients. Mean operation-time and mean hospital stay of standard PCNL was predominant. Conclusion: Tubeless PCNL proved to be the safest and most effective. Keywords: Comparison, standard, tubeless percutaneous, nephrolithotomy.

Comparison of Efficacy and Outcome of Tubeless with Standard Percutaneous Nephrolithotomy in Patient with Renal Stones

Objective: To compare the outcome and complications of standard PCNL with tubeless PCNL in terms of analgesia requirement, incidence of infection, post-operative perinephric urinary collection and post-operative hospital stay. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Lahore General Hospital Lahore from 1st March 2018 to 30th April 2019. Methodology: Ninety six patients fulfilling the inclusion criteria were randomly categorized into 2 groups; Group A where patients will undergo standard PCNL and Group B where patients will undergo tubeless PCNL. Post-operatively, patients were assessed for the requirement for analgesia, rate of infection, post-operative urinary leakage and hospital stay. Results: The mean duration of surgery had no significant difference between the two treatment groups; tubeless group was on average 51 minutes while the standard PCNL group was 55 minutes. No significant difference was observed in reduction of hematocrit values between the groups (4.9% vs 4.2%). Transfusions were not required in either group. The average post-operative duration of hospital stay was 2 days in group 1 and group 2 was 3 days with P&lt;0.001. Conclusion: Tubeless PCNL is effective in patients with kidney stones and requires fewer analgesic drugs and shorter hospital stay, post-operative complications are almost the same in both groups with no significant difference. Key words: PCNL, Standard, Tubeless, Complications

Outcome of Standard Percutaneous Nephrolithotomy and Totally Tubeless Percutaneous Nephrolithotomy for Renal Calculi: A Comparative Study

Objective: In standard PCNL usually placement of a double J stent and a nephrostomy tube is required.Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PCNL). Postoperatively,In standard PCNL patients have an indwelling ureteric stent placed, which is often associated with stent-related morbidity. We performed totally tubeless(without any stent or nephrostomy tube) PCNL.This study was conducted in the urology centre of Combined military Hospital,Dhaka, to evaluate the safety, effectiveness, and feasibility of totally tubeless PCNL and to compare with standard PCNL where both nephrostomy tube and double J stent were placed. Materials and Methods: From January 2018 to June 2019 , total 57 selected patients underwent standard or totally tubeless PCNL.In standard PCNL group, both D-J stent and nephrostomy tube were placed and Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PCNL group. We compared patient demographics and stone characteristics, operation time, length of hospital stay, analgesia requirements, stonefree rate, blood loss, change in creatinine, and postoperative complications between the standard and totally tubeless PCNL groups. Results: There were no significant differences in preoperative patient characteristics, postoperative complications, and the stone-free rate between the two groups, but the totally tubeless PCNL group showed a shorter hospital stay and a lesser analgesic requirement compared with the standard PCNL group. Blood loss and change in serum creatinine level were not significantly different between the two groups. Conclusions: Totally tubeless PCNL appears to be a safe and effective alternative for the management of renal stone in selected patients and is associated with a shorter length of hospital stay and less analgesic requirement. Bangladesh J. Urol. 2021; 24(1): 53-57

Prospective randomized study comparing safety and efficacy of standard versus tubeless percutaneous nephrolithotomy

Objective:To prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL. Patients and methods:220 patients undergoing PCNL were randomized to two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with nephrostomy tube placement postoperatively with 110 patients in each group.Inclusion criteria were stone size more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter Results:There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the complications, stone clearance, need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively. Conclusion:Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower), in patients with bilateral disease and effective procedure if done in a selected group of patients.

Complications of Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Objective: To compare grade I complication as per Clavien-Dindo classification in patients undergoing standard (with tube) verses tubeless percutaneous nephrolithotomy. Study design: Hospital based randomized control study. Place and Duration of Study: Urology Clinic, Sindh Institute of Urology &amp; Transplantation Karachi from 3rd June 2016 to 2nd December 2016. Methodology: Seventy four patients (37patients) in each group were enrolled. In group 1 patients, a 20 F nephrostomy tube were placed in the kidney over the guide wire, which was removed later. Group II patients had antegrade placement of a Double-J stent without nephrostomy and the wound compressed for 5min. The demographic like age, gender and complications grade I complications according to Clavian-Dindo classification were noted. Results: The mean age was 49.42±7.06 years. There were 46 (62.16%) males and 28 (37.84%) females. There was no significant difference in stone clearance rate between the groups; 91.9% in standard percutaneous nephrolithotomyg roup and 94.6% in tubeless percutaneous nephrolithotomy group. Need for analgesics for pain control was high in standard percutaneous nephrolithotomy group 86.5% versus 64.9% in tubeless percutaneous nephrolithotomy group (p=0.03). Frequency of urine leakage was 18.9% in standard percutaneous nephrolithotomy group and only 2.7% in tubeless percutaneous nephrolithotomy group (p=0.02). Conclusion: Tubeless percutaneous nephrolithotomy procedure has fewer complications as per Clavien-Dindo classification regarding need for analgesics and urine leakage. In suitable cases, the tubeless procedure can be safely used as the standard for percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy (PCNL), Clavien-Dindo classification, Complication

Comparison of Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P &gt; 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.

Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high-grade hydronephrosis

Percutaneous nephrostomy (PCNL) and retrograde intrarenal surgery (RIRS) are the two main treatments for upper urinary tract stones. The aim of our study was to compare the effectiveness and safety of standard PCNL (S-PCNL) and RIRS for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. The study included 118 patients who underwent surgery for stones at ureteropelvic junction. S-PCNL and RIRS were performed on 66 and 52 patients, respectively. Patient age, sex, body mass index (BMI), stone side, history of urinary tract infection (UTI), history of diabetes, history of ESWL, stone size, Hounsfield unit (HU) values of stones, grade of hydronephrosis, operating time, postoperative hemoglobin loss, narcotic analgesic use, postoperative transfusion rates, stone-free rates (SFRs), length of hospital stay, complication rates and number of secondary interventions were recorded. The comparison of the operative data between the two groups revealed no statistically significant differences in the operative time, SFRs, narcotic analgesic use, postoperative transfusion rate or other postoperative complications defined according to the Clavien system (P > 0.05). The postoperative urinary sepsis rate in the RIRS group was as high as 15.4%, which was much higher than the 1.5% rate observed in the S-PCNL group, and the difference was statistically significant (P < 0.05). A total of 13.5% of the patients in the RIRS group required a second operation due to failure of the placement of the ureteral access sheath. Additionally, S-PCNL had an advantage in operation time, while RIRS in duration of hospital stay and postoperative hemoglobin loss. RIRS and S-PCNL were safe and effective methods for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. Importantly, S-PCNL had more advantages in terms of the postoperative urinary sepsis rate and secondary surgery rate.

Tubeless PNL can safely be applied to selected patients in pediatric stone disease.

The purpose of this study was to compare the results of tubeless percutaneous nephrolithotomy (TPNL) and standard percutaneous nephrolithotomy (SPNL) for the management of nephrolithiasis in children. The data for 48 patients aged lesser than 18 years who underwent percutaneous nephrolithotomy (PNL) between January 2010 and June 2018 were reviewed retrospectively. The patients were classified into 2 categories depending on tube placement. A total of 21 patients were treated with TPNL and 27 with SPNL technique. The surgical method employed was selected depending on intraoperative complications. The size of the endoscopic instrument (mini/standard) to be used was decided according to the stone burden and surgeon preference. A complete stone-free rate (SFR) was achieved in 85.7% (n=18) of the TPNL group and 85.2% (n=23) of the SPNL group (p=0.959). In the TPNL group, two patients with clinically significant stones underwent retrograde intrarenal surgery, and one patient with clinically insignificant residual stone remained under follow-up. In the SPNL group, two patients with clinically significant stones underwent repeat mini-PNL surgery, the stones being fragmented with shock wave lithotripsy in one patient, and 1 one patient with insignificant residual stone remained under follow-up. No significant differences were observed in terms of intraoperative and postoperative complications, mean SFRs, or operative and fluoroscopy times. However, a statistically significant difference was observed in lengths of hospital stay (p<0.001). TPNL is a safe and effective procedure in children. No significant difference was found between TPNL and SPNL in terms of stone clearance; however, patients undergoing TPNL had significantly shorter hospital stays.

Does Miniaturization Actually Decrease Bleeding After Percutaneous Nephrolithotomy? A Single-Center Randomized Trial.

Introduction: Miniaturization of percutaneous nephrolithotomy (mPCNL) was proposed to decrease postoperative bleeding, as there is decreased parenchymal injury compared with standard percutaneous nephrolithotomy (SPCNL). Published randomized controlled trials (RCTs) evaluating bleeding after mPCNL have shown conflicting results. Hence, the evidence to say that mPCNL offers less postoperative bleeding is not robust. Materials and Methods: Prospective RCT was done by comparing mPCNL and SPCNL for treatment of renal stones of size 1 to 3 cm. Patients with active urinary tract infection, renal malformation, uncorrected coagulopathy, and raised serum creatinine (>1.5 mg/dL) were excluded. Blood loss was evaluated by measuring fall in hemoglobin and hematocrit on postoperative day 1. Postoperative pain was evaluated by visual analogue scale (VAS) score at 6, 24, and 48 hours. Results: A total of 60 patients (30 in each arm) were enrolled during the study period. All the baseline preoperative variables were comparable in both the groups. The SPCNL group had a significantly higher drop in hematocrit level as compared with mPCNL (4.6 ± 3.1% vs 3.1 ± 2.1%, p = 0.02). The mean fall in hemoglobin was higher in SPCNL as compared with mPCNL (1.61 ± 0.9 gm% vs 1.21 ± 0.7 gm%, p = 0.07), but it was not significant. Blood transfusion (BT) rate was comparable in both the groups (one patient in each group). The mPCNL group had significantly less VAS scores at 6 hours (3.27 ± 1.20 vs 4.40 ± 1.52, p = 0.002) and 24 hours (2.10 ± 0.54 vs 2.83 ± 1.05, p = 0.001) after surgery. Postoperative complications and hospital stay were comparable in both the arms. Conclusion: mPCNL is associated with less postoperative bleeding and pain than SPCNL. However, the small tract size does not prevent against the clinically significant bleeding requiring BT.

Treatment of renal stones by standard percutaneous nephrolithotomy versus modified mini percutaneous nephrolithotomy in Yala Hospital: A comparative study

Objective: The aim of this study was to compare the postoperative outcomes of patients receiving standard percutaneous nephrolithotomy (S-PCNL) and modified mini percutaneous nephrolithotomy (MM-PCNL) in Yala Hospital. Material and Method: We collected data from 117 patients who underwent S-PCNL or MM-PCNL from 2013-2018. We compared the data of patient characteristics, laboratory results, and postoperative outcomes, such as operative times, duration of catheter, blood transfusion rate, duration of hospitalization, stone free rate and complication rate between the S-PCNL and MM-PCNL groups. Results: There were no significant differences in operative time, blood transfusion rate, stone free rate and complication rate between the 2 groups. However, the duration of catheter and hospitalization in the MM-PCNL group was significantly shorter than in the S-PCNL group. Conclusion: Hence, we confirmed that MM-PCNL could be used as an alternative procedure to Mini-PCNL for the management of renal stones in other tertiary hospitals which already have the equipment for S-PCNL by modifying that equipment, as we have shown.

Miniaturization of PCNL; Necessity or What?

Objective: Now a days, percutaneous nephrolithotomy (PCNL) is the treatment of choice for retrieval of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study was to compare the safety and efficacy of PCNL using different tract size.&#x0D; Patients and Methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Mini or by Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chattogram from July 2016 to October 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, access time, fluoroscopy time for access, total operative time, need for blood transfusion, postoperative hospital stay, postoperative pain, fever, urinary leakage and other complications between two groups. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded.&#x0D; Results: A total of 78 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini-PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.59±0.89 cm, and 2.66±0.97 cm in standard-PCNL group (p=0.7). Mean tract size was 18.53 ± 1.29 F (16-20) and 26.11 ± 4.61 F (24-30) respectively with P value &amp;lt;0.001. In mini-PCNL operative time was significantly longer than that of standard PCNL with 112.11 ± 20.29 vs. 98.68± 19.75 minutes respectively with p=.004. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.26 vs. 0.83 ± 0.32 gm%, p value 0.001) and hospital stay (2.18 ± 0.77 vs. 3.39 ± 1.10 days, p value= 0.001), respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.84% vs. 92.11%, p=0.45). There was no statistical difference in terms of visual analogue scale (VAS) score (5.55±1.54 vs. 6.24±1.6) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10.52% vs 12.50%, p=0.72). No statistical difference was recorded in terms of postoperative fever (eŠ38C) between two groups (2 in each group, 5.2%, p=1 Blood transfusion requirement was much less in mini PCNL group (10.52% vs. 34.2%, p=0.01).&#x0D; Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct tostandard PCNL, URS, and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.11-16

Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size.&#x0D; Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded.&#x0D; Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%).&#x0D; Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

Standard versus mini-percutaneous nephrolithotomy for renal stones: a meta-analysis.

To compare the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in order to determine the optimal tract size for patients with renal stones. A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through 20 August 2019, reporting on a comparison of the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 763 studies, 14 were considered for the evidence synthesis. A total of 1980 cases were included. Of these patients, 897 cases underwent standard percutaneous nephrolithotomy, and 1083 cases underwent mini-percutaneous nephrolithotomy. Stone-free rates were 87.6% (786 of 897 patients) for standard percutaneous nephrolithotomy and 87.8% (951 of 1083 patients) for mini-percutaneous nephrolithotomy (p = 0.57). Tract sizes of 30F and 22-26F in standard percutaneous nephrolithotomy group shorten operation time compared with mini-percutaneous nephrolithotomy (p = 0.02; p = 0.004; respectively). Leakage (p = 0.04), bleeding (p = 0.01), blood transfusion (p < 0.00001), and renal pelvis perforation (p = 0.02) were more common in standard percutaneous nephrolithotomy group than in mini-percutaneous nephrolithotomy group. Subgroup analysis showed only blood transfusion for 30F and 22-26F standard percutaneous nephrolithotomy group was more common than mini-percutaneous nephrolithotomy (p < 0.0001, p = 0.005, respectively). Standard percutaneous nephrolithotomy was associated with higher leakage, bleeding, blood transfusion, and renal pelvis perforation, but had a shorter operation time. Tract size of 30F improved the stone-free rate compared with mini-percutaneous nephrolithotomy, but led to more complications. Tract size of 22-26F was no better than 30F or mini-percutaneous nephrolithotomy.