Ultra-mini Percutaneous Nephrolithotomy Research Articles

A Comparative Study between Ultra mini Percutaneous Nephrolithotomy versus Stented Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones in Egypt

Abstract Background Nephrolithiasis is the third most common disease of the urinary tract with a 1-year recurrence rate of 7% and 10-year recurrence rate of 50%. Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL) are different surgeries to treat renal stones. Percutaneous nephrolithotripsy (24- 30F) remains the standard procedure for treating large renal calculi. While achieving high SFR, it also has many drawbacks such as bleeding, postoperative pain, and a long recovery period due to its large access tract, so the Ultra mini percutaneous nephrolithotripsy (12-14F) with a smaller tract size came into existence to reduce renal parenchymal injury associated with standard PCNL. ESWL is a minimally invasive intervention with good patient tolerance; it is regarded as the first line treatment for nephrolithiasis < 20 mm in size. Aim andObjectives Compare results, safety and outcome of Ultra mini PCNL versus stented extracorporeal shock wave lithotripsy (ESWL) for the management of renal calculi from 10 – 20 mm. Materials and Methods This study was conducted at Urology department, Faculty of Medicine, Ain Shams University. Patients were recruited from the outpatient urology clinic between March 2021 till September 2022. Inclusion criteria included patients between 18 and 60 years, having radioopaque renal stones ranging from 10-20 mm with BMI not exceeding 40. Exclusion criteria were patients who had radiolucent stones, smaller than 10 mm or larger than 20 mm, with congenital renal anomalies or spinal deformity or BMI exceeding 40. Patients with uncorrected bleeding diathesis or pregnant females or untreated UTI were also excluded. After meeting our inclusion and exclusion criteria, 90 patients were thoroughly informed about the study, feeling well about participating in it, an informed written consent was taken from them. Patients were randomized to either Ultra-Mini-Percutaneous nephrolithotomy group or stented SWL group via the closed envelope method(each group 45 patients). Results Stone free rate was higher in the Ultra-mini-PCNL group compared to the stented ESWL group with no statistically significant difference with P-value = 0.316. As for the need for retreatment was slightly higher in the stented ESWL group compared to the Ultra-mini-PCNL group yet this difference was statistically insignificant with P-value 0.681. No statistical significant difference between both groups regarding post operative complications fever, hematuria and need for blood transfusion respectively. Operative time and hospital stay were significantly higher in the ultra-Mini-PCNL group compared to the stented ESWL group with P-value <0.001 for both. Conclusion Both stented ESWL and Ultra-Mini-PCNL are good treatment choices for renal stones less than 2 cm with low complication rates. Denying Ultra-Mini-PCNL from patients with medium sized stones for fear of complications is considered unwarranted. Stone size indices were significant predictor for the need of retreatment. Further studies to compare stone free rate based on stone size in both interventions are needed.

Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region.

In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. Infants under 24months old with kidney stones of 2cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. A total of 26 patients were included in the study. The mean age of the patients was 17.3±3.90 (12-24) months. The mean operation time was 50.7±6.43min. The mean stone size was 2.66±0.59cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24months of age with kidney stones larger than 2cm. It provides high-stone clearance rates and low complication rates.

Superperc: Minimally-Invasive Percutaneous Nephrolithotomy Initial Experience

Introduction: For the management of renal stones, Percutaneous nephrolithotomy (PCNL) has undergone significant changes in the last few years in the quest for improving efficacy and reducing morbidity. Minimally-invasive modalities of PCNL, such as mini- PCNL, ultra-mini PCNL, and micro-PCNL, have evolved with advancements in optics and technology. However, with these newer advancements, the migration of small fragments produced with laser lithotripsy remains a concern, which may result in incomplete stone clearance. A new technique of PCNL is termed “Superperc” that utilizes suction to remove all the fragments and maintain a one-way flow. Methods: This study involved 35 consecutive patients who underwent PCNL with the Superperc technique from March 2020 to December 2020. Surgery was performed using a pediatric ureteroscope used as a nephroscope and a specially designed sheath with a suction attachment. The Superperc uses a 10/12 F tract size, a specially designed Superperc sheath (Shah Sheath) with a suction mechanism, and a pediatric ureteroscope 4.5/6. Results: The age range is 20-65 years, with 23 males and 12 females. Stone size was 1- 3 cm, and operative time was 30-90 min. Upper calyceal punctures 7cases , 19 had middle, 6 lower calyceal and 3 had two punctures. DJ stent was placed in 7 patients, whereas 28 patients had a ureteric catheter for 24 hours. Only three patients required a nephrostomy tube. No blood transfusion. Postoperatively one patient had a mild fever, and one had transient hematuria. Complete stone clearance as per nephroscopy &fluoroscopy. The hospital stay was 24-72 h. Conclusion: Superperc is a new technique of minimally-invasive PCNL and can be successfully done with minimal modification in the armamentarium, with the potential advantage of good stone clearance. Bangladesh J. Urol. 2022; 25(2): 71-75

Simultaneous Antegrade and Retrograde Endoscopic Management of Complete Short-Segment Ureteroileal Anastomotic Stricture: Technique and Early Outcome

Background: Ureteroileal anastomotic strictures have a prevalence of up to 10%. Although open surgical revision remains the gold standard treatment, endoscopic and robotic approaches are described to reduce morbidity.1 Patients with complete occlusive strictures are usually not considered candidates for endoscopic management. There are limited publications with small number of patients who employed endoscopic management for complete occlusive ureteroileal anastomotic stricture. Objective: The aim of this video is to describe surgical approach in a stepwise manner for endoscopic management of a complete short-segment (<1 cm) ureteroileal anastomotic stricture.2–6 Methods: A 51-year-old woman underwent an anterior pelvic exenteration and ileal conduit followed by adjuvant chemoradiotherapy for cervical cancer management. After 1 year, she underwent nephrostomy tube placement for pyelonephritis associated with a left hydroureteronephrosis. Subsequent antegrade nephrostogram demonstrated a complete ureteroileal anastomotic stricture. The patient was counseled regarding various management options, and she opted for endoscopic management. Under general anesthesia we initially performed a flexible cystoscopy through the ileal conduit and were unable to identify the left ureteroileal anastomotic site. We then dilated percutaneous renal access and placed 13F ultra-mini percutaneous nephrolithotomy sheath in kidney under fluoroscopic guidance. Antegrade simultaneous ureteroscopy and nephrostogram confirmed a short-segment complete stenosis of ureteroileal anastomosis. Using 200 micron holmium laser fiber at 1 J × 10 Hz, we incised the distal blind end of ureter near conduit allowing passage of the ureteroscope in periureteral tissue. We then incised the ileal conduit, allowing antegrade advancement of a guidewire into the conduit. This wire was retrieved cystoscopically through an ileal conduit and secured at the level of stoma. Finally, a 7F/14F endoureterotomy stent was placed followed by nephrostomy tube placement. Results: The patient had an uneventful postoperative recovery and was discharged home the next day with an open nephrostomy tube. After 10 days, we confirmed free drainage of contrast into the conduit without extravasation on antegrade nephrostogram and clamped the nephrostomy tube. We later removed nephrostomy tube at 2 weeks and endoureterotomy stent by office cystoscopy at 6 weeks. At 3-month and 1-year follow-up, the patient remained asymptomatic. A renal ultrasonography revealed residual mild left hydronephrosis and a renal scan showed stable split left renal function of 25% with adequate drainage. Conclusion: Our video provides detailed technical nuisances to novice endourologist for a safe and effective treatment of a complete short-segment ureteroileal anastomotic occlusion with simultaneous antegrade and retrograde endoscopic management. No competing financial interests exist. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 58 secs

PERCUTANEOUS APPROACH TO THE KIDNEY: SIMILARITIES AND DIFFERENCES OF VARIOUS TECHNIQUES - EXPERIENCE IN OSIJEK UNIVERSITY HOSPITAL CENTER.

Today, percutaneous nephrolithotomy (PCNL) is a standard procedure in the treatment of large kidney stones. Development of the procedure began in 1976 with publication of the first reports, while turning point came in 1985 when the first 250 cases were described. Subsequently, PCNL has become standard in the treatment of kidney stones instead of open surgery. Numerous modifications of the procedure have been developed with advancement of modern technology. Nevertheless, there is still the necessity for clearer understanding of differences and circumstances of choice among different techniques. There are significant differences in the instruments used for the procedure, so we distinguish standard PCNL (working channel of 24-30 Fr), mini PCNL (working channel of 11-18 Fr), ultra-mini PCNL (working channel <15 Fr), and micro PCNL (working channel <6 Fr). With the development of flexible ureteroscopy (FURS), a combined method is also being developed, i.e., Endoscopic Combined IntraRenal Surgery (ECIRS, PCNL + FURS). Furthermore, each procedure can be performed in prone or supine position. The aim of this paper is to point out the similarities and differences, the advantages and disadvantages of different techniques, with an additional aim to present our experience and current standard practice in kidney stone treatment.

Initial Experience of Totally Tubeless Ultra-Mini Percutaneous Nephrolithotomy

Objectives : The Objectives of this study is to determine the outcome and effectiveness of Ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal stone without placement of any stent and nephrostomy tube as a supplement to the conventional PCNL. Material and methods: The Patients who underwent ultra-mini PCNL bwtween July 2018 to December 2018. were studied.This was a prospective study of 14 patients.This study was carried out in urology centre of CMH Dhaka.Before the study ethical clearance was taken from hospital ethical committee. All these patients had their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 1.5 cm in its maximal dimension. The mean stone size was 10.8+_4.2(5-15mm). An 6 Fr operating nephroscope was used. The patients were placed in prone position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed.The stone free rate was assessed on the 1st day and at three month after surgery by X-ray KUB and ultrasonography. Results: The study includes a series of 14 patients (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=7; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40–65) and the stone-free rate was 93.3% at first day and 97% after three month follow up.. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. Conclusion: Ultra-mini PCNL in prone position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume stone disease. A long term large scale multicentre study may be required to validate this technique. Bangladesh J. Urol. 2021; 24(2): 118-123

What is the best approach for pediatric kidney stones of moderate-sized between shock wave lithotripsy, ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery?

This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10-20mm size. The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Comparison between standard, mini and ultra-mini percutaneous nephrolithotomy for single renal stones: a prospective study.

Based on the current trend of miniaturization of instruments used in percutaneous nephrolithotomy (PCNL), it is necessary to compare different PCNL modalities regarding their access sheath size used. Thus, the safety and efficacy among standard, mini and ultra-mini PCNL (s-PCNL, m-PCNL, um-PCNL) were compared. We performed a prospective, non-randomized trial between January 2018 and July 2020. Patients with stones classified as Guy's stone score grade I were included. The set-up for s-PCNL and m-PCNL included a 30Fr and 22Fr percutaneous tract, respectively. In both set-ups, an ultrasonic/ballistic lithotripter was utilized. In the case of um-PCNL, a 12Fr percutaneous tract was established. A high-power laser was used for lithotripsy. Hemoglobin drop, complication rate, length of hospital stay (LOS), stone-free rate (SFR) and operation time were evaluated. A total of 84 patients, 28 patients per method, were evaluated. Hemoglobin drop was higher in the s-PCNL group when compared to m-PCNL (p = 0.008) and um-PCNL groups (p < 0.001), while um-PCNL group had the slightest hemoglobin drop. LOS was similar between s-PCNL group and m-PCNL group, but um-PCNL group required shorter hospital stay than the other two modalities (p < 0.001). The complication and transfusion rates as well as SFR did not differ between groups. Operation time in the um-PCNL set-up was longer compared to s-PCNL (p < 0.001) and m-PCNL (p = 0.011), whereas s-PCNL and m-PCNL did not differ significantly. m-PCNL showed less hemoglobin drop, but similar operation time and SFR when compared to s-PCNL. um-PCNL showed even less hemoglobin drop, but the operation time was longer compared to the two other modalities.

Flank-Free Modified Supine vs Prone Ultra-Mini-Percutaneous Nephrolithotomy in Treatment of Medium-Sized Renal Pelvic Stone: A Randomized Clinical Trial.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the standard treatment of renal stone >2 cm. Ultra-mini-percutaneous nephrolithotomy (UMP) had emerged in the past decade as a new technique in treating renal stones <2 cm. In this study we compared between the outcome of UMP in prone position with the outcome of UMP in modified flank free supine position (FFSP). Materials and Methods: A prospective randomized study was conducted between January 2016 and April 2020, including 122 patients, divided into two matched groups. Group A included 61 patients who underwent UMP in FFSP, and Group B included 61 patients who underwent UMP in a prone position. All patients had a single renal pelvic stone 1-2 cm. Patients with a single kidney, renal anomalies, body mass index ≥40 kg/m2, history of ipsilateral renal surgery, and age <18 years were excluded. In both groups, the dilatation was done up to 13F; a holmium laser was used through a 9F ureteroscope for fragmentation. Nephrostomy tube and ureteral stent were used only when indicated. Results: In total, 122 patients were divided into two groups. The mean age was 40.09 ± 13.63 and 39.67 ± 13.80 years in both groups, respectively. The operative time was 63.64 ± 9.22 and 78.48 ± 9.55 minutes in Groups A and B, respectively (p = 0.0001). The fluoroscopy time was 3.47 ± 0.56 and 4.45 ± 0.39 minutes in Groups A and B, respectively (p = 0.0001). No significant difference was shown between both groups regarding operative and postoperative complications. Shift to mini-PCNL was needed in one patient in Group A and four patients in Group B because of impaired vision. The hospital stay was 25.36 ± 4.23 and 26.13 ± 4.76 hours in both groups, respectively. The initial stone-free rate was 95.1% and 91.8% in both groups, respectively. Conclusions: UMP in modified supine position shows comparable results with UMP in the prone position regarding stone-free rate, hospital stay, and perioperative complication, with significantly shorter operative and fluoroscopy time.

Efficacy of ultra-mini percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of 2-3 cm lower calyceal stones

We aimed to compare the efficacy and safety of ultra-mini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) for the management of lower calyceal stones. A group of 136 patients with a single lower calyceal stone (2-3 cm in diameter) was divided into the UMP or RIRS groups. The average operation time in the RIRS group was significantly longer than that in the UMP group, and the intraoperative blood loss in the former was markedly less than that in the latter. Besides, in the RIRS group, the decreased value of postoperative Hb was obviously lower, the postoperative hospital stay was evidently shorter, and the total hospitalization expenses were markedly less than those in UMP group were. Moreover, the success rate of the first-stage lithotripsy in the UMP group was notably higher than that in RIRS group. The RIRS group had an obviously lower VAS score but a markedly higher BCS score than the UMP group six hours after surgery. At 24 h after operation, the levels of serum CRP, TNF-α and IL-6 in patients in both groups were remarkably increased, and they were evidently lower in the RIRS group than those in the UMP group were. Three days after surgery, the levels of serum CRP, TNF-α and IL-6 were notably lower in the UMP group than those in RIRS group were. RIRS and UMP are safe and effective in the treatment of 2-3 cm lower calyceal stones. The first-stage UMP is characterized by a high stone-free rate (SFR), short operation time and low postoperative infection risk, while RIRS is associated with less blood loss and low total expenses.

Comparison of Ultra-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Stones: A Systematic Review and Meta-Analysis from the KSER Update Series.

Miniaturized percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for renal stones have been developed to overcome the invasive disadvantages of PCNL. We aimed to compare the therapeutic effect and safety of ultra-mini percutaneous nephrolithotomy (UMPCNL) and RIRS for renal stones using an updated systematic review and meta-analysis. We searched clinical trials comparing UMPCNL and RIRS for renal stones using the PubMed, EMBASE, Cochrane Library, and Google Scholar databases up to October 2021. Seven studies were included in the current study. The renal stone size was 10–20 mm in three studies, 10–25 mm in one study, 10–35 mm in two studies, and not specified in one study. The stone-free rate of UMPCNL was higher than that of RIRS (p = 0.02; odds ratio (OR) = 2.01; 95% confidence interval (CI) = 1.12, 3.61). The complication rate showed no significant difference between UMPCNL and RIRS (p = 0.48; OR = 1.20; 95% CI = 0.73, 1.98). Regarding the operative time, UMPCNL was shorter than RIRS (p = 0.005; weighted mean difference (WMD) = −15.63; 95% CI = −26.60, −4.67). The hospital stay of UMPCNL was longer than that of RIRS (p = 0.0004; WMD = 1.48; 95% CI = 0.66, 2.31). UMPCNL showed higher efficacy than RIRS and similar safety to RIRS. UMPCNL may be a useful therapeutic option for moderate-sized renal stones.

Ultra-Mini-Percutaneous Nephrolithotomy in Flank-Free Modified Supine Position vs Prone Position in Treatment of Pediatric Renal Pelvic and Lower Caliceal Stones.

Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flank-free modified supine (FFMS) and prone positions in management of pediatric renal calculi. Patients and Methods: This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for UMPCNL. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13F sheath allowing the introduction of 6/7.5F semirigid ureteroscope and fragmentation of stones by Holmium: yttrium-aluminum-garnet laser with a 550-μm fiber laser lithotripter. Results: The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3 ± 9.87 vs 99.3 ± 8.75 minutes) with p = 0.022. There was no significant difference between both groups in terms of stone-free rate (89.3% vs 88.9%), overall complication rate (including transient fever; 21.4% vs 18.5%), postoperative pain (visual analog scale score; 3.4 ± 0.8 vs 3.3 ± 0.9), or hospital stay (3.53 ± 0.8 vs 4.1 ± 1.1 days). Conclusion: Both UMPCNL in FFMs and prone positions are feasible, safe, and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.

Effect of ultra-mini percutaneous nephrolithotomy and ShuoTong ureteroscopy on the stress response, inflammatory indices, and urokinase level in patients with polycystic kidney disease complicated with renal calculus.

This study aimed to explore the effects of ultra-mini percutaneous nephrolithotomy (UMP) combined with ShuoTong ureteroscopy on the stress response, inflammation indicators and urokinase levels in patients with polycystic kidney disease and kidney stones. In this study, 42 patients with polycystic kidney disease and kidney stones diagnosed and treated in our hospital from February 2018 to February 2021 were selected as the research objects. They were randomly divided into the control group and the study group, with 21 cases in each group, and the control group adopted Ultra-mini percutaneous nephrolithotomy treatment; the study group was combined with ShuoTong ureteroscopy on the basis of the control group, and compared and analyzed the stress response, inflammation indexes, urokinase level, renal function, complications and stone clearance rate of the two groups of patients. After treatment, the average operation time, channel establishment time, hemoglobin decline, number of puncture channels, and hospital stay in the study group were significantly shorter than those in the control group (P<0.05); after treatment, the reduction in CRP and PCT in the study group was significantly higher than that in the control group The increase of Ang I and Ang II in the control group was significantly lower than that in the control group (P<0.05); the improvement of PGE2, NO, and LPO levels in the study group was significantly higher than that in the control group after treatment (P<0.05); the study group TH, Cys- The levels of C and β2-MG were significantly lower than those of the control group; the UK levels of the study group were significantly lower than those of the control group (P<0.05); the complication rate of 14.29% in the study group after treatment was significantly lower than that of the control group 33.33%; the study group The stone clearance rate of 95.24% was significantly higher than that of the control group 80.95% (P<0.05). In general, UMP combined with ShuoTong ureteroscopy is used to treat polycystic kidney with kidney stones, accurately determine the tip position of the needle sheath, ensure that the needle sheath enters the collection system to adjust its position, reduce patient stress and inflammation, improve safety and feasibility, and is worthy of clinical practice Promote applications.

Ultramini-percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of 10-30mm calculi: a randomized controlled trial.

The surgical management of renal stones 10-30mm is usually performed with percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Standard form of percutaneous nephrolithotomy has paved the way for miniaturized PCNL in many centres. We wanted to evaluate the efficacy, safety and the cost-effectiveness of ultramini-percutaneous nephrolithotomy (UMP) versus RIRS in the treatment of renal stones with stone burden 10-30mm. Patients with renal stone burden 10-30mm were prospectively randomized into either UMP or RIRS. The demographic data, stone characteristic, operative time and cost of the equipment were recorded. The stone free status, analgesic requirement, deterioration of the renal function and hemoglobin and the postoperative complications as per Clavein-Dindo grade were recorded. One hundred and fifty patients met inclusion criteria. Out of these 98 underwent UMP and 46 RIRS. Six withdrew the consent before the procedure. Mean stone size was comparable in either of the groups. Mean laser time and stone extraction time was significantly less for UMP compared to RIRS (41.17min versus 73.58min p < 0.0001). Mean consumable costs in the UMP group were considerably less at US$45.73 compared to the RIRS group at $423.11 (p < 0.0001). The stone free rates at 1 month of follow-up were 100% for UMP group and 73% for RIRS group. There were insignificant changes to mean hemoglobin and glomerular filtration rate (GFR) in all patients and the average length of the stay was similar in both the groups. The postoperative complications revealed Grade I and II rate of 10% in the UMP group and 35% in the RIRS group, respectively. We concluded that UMP to be safe, effective and more economical to the RIRS for renal stones up to 3cm in size.Trial registered with ISRCTN registry ID ISRCTN20935105, Retrospective.

Ultra-Mini Percutaneous Nephrolithotomy (UMP) with Strict Lower Irrigation Pressure Control: Correlation with Post Operative Febrile Urinary Tract Infection Rate.

Ultra-mini PCNL (UMP) is a device that removes stones by using 7.5 Fr. nephroscope and 11/12 Fr. working sheath. The stone free rate (SFR) does not lag behind the convetional PCNL, but due to the diameter of the small device, UMP has many disadvantages; Irrigation pressure increases easily during surgery and post operative febrile urinary tract infection (UTI) is relative common. The purpose of this study is to present the surgical results of UMP with strict irrigation pressure control using a pressure control irrigator. 70 consecutive patients who underwent UMP surgery for kidney stones were enrolled retrospectively. All surgeries proceeded with the shoulder rotated supine position. Of these, initial 35 patients underwent surgery using 100 mmHg irrigation power previously and later 35 patients underwent surgery below 40 mmHg irrigation power. The stone size of the UMP 100 mmHg group was 2.52 ± 1.05 and that of the UMP 40 mmHg group was 2.79 ± 1.32 respectively. Operative time was also slightly shorter in the UMP 40 mmHg group, but there was no statistical difference between the two groups. There was no statistical difference in stone free rate, but UMP 100 mmHg group showed 37.1% of post operative febrile urinary tract infection rate and 11.4 % in UMP 40 mmHg group and they are significantly different (p = 0.039). Strict irrigation pressure control below 40 mm during UMP can reduce post operative febrile UTI without affecting SFR.

Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review.

PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS). Of the 294 studies initially identified through database searching, nine papers published between 2019 and 2021 were included which compared laser PCNL (Standard PCNL in three, mini-PCNL in four, ultra-mini PCNL in one, micro-PCNL in one study) to other nonlaser lithotripsy, ESWL, FURS, and different PCNL sizes. Complications for laser PCNL ranged from bleeding (4.4%), perirenal haematoma (1.1%), fever (4.6%), ureteric/renal pelvic injury (2.3%), haematuria (2.7%), and infection (2.6%). The mean SFR for laser PCNL was 91.5% at 3 months. Percutaneous laser nephrolithotripsy is well tolerated and effective, with high-SFRs at 3 months and relatively low intraoperative and postoperative complication rates. Further research is required to assess the role of intraoperative techniques and suction to improve outcomes further.

Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population

ObjectiveTo evaluate whether there would be a difference in outcome when the smaller ultra-mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy (PCNL) in paediatric patients for stones less than 25 mm. MethodsThis was a prospective cohort study of patients who underwent PCNL in our hospital in a 2-year period from July 2016 to June 2018 by a single surgeon. PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation. Laser was used to fragment the stone. Stone-free outcome was defined as absence of stone fragment at 3 months on kidney, ureter, and bladder X-ray. ResultsThere were 40 patients in each group. Mean stone size was comparable between the two groups (14.5 mm vs. 15.0 mm). The procedure was completed faster in the 16 Fr group compared to 12 Fr group (24.5 min vs. 34.6 min). Stone clearance was highly successful in both groups (97.5% vs. 95.0%). There was no difference in complications between the two groups. The decrease in hemoglobin was minimal in both groups (0.2 g/dL vs. 0.3 g/dL). ConclusionWe found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups. No significant difference in bleeding was noted in our pilot study, however, operative time was longer in the ultra-mini group as compared to the mini sheath group.

Tips and Tricks to Improve Ergonomics, Efficacy, Versatility, and Overcome Limitations of Micro Percutaneous Nephrolithotomy.

Percutaneous Nephrolithotomy (PCNL) has evolved over the decades from Standard to Mini to Ultramini PCNL to Micro-perc, with miniaturisation being the dominant theme and supine approach gaining momentum world over.Aim: In literature, miniaturised PCNL with microperc needle access system has raised concerns of intrarenal pressure and has some limitations with its success for larger stones. Our tips and tricks explain how to overcome these pitfalls by utilising the full construct of the needle system to its maximum potential. These will in turn help make the procedure versatile, precise, ergonomical, and enhance a surgeon's experience with improved outcomes for patients especially in large renal stones.Materials and Methods: We describe the limitations of microperc needle access as stated in literature and proposals by the co-authors using microperc for miniaturised access on how to overcome the same.Results: A simplified table describing the limitations and tips and tricks on overcoming these is provided for quick reference.Conclusion: As Technological advancements and techniques for miniaturised access in urolithiasis improve, we believe our suggestions will help surgeons overcome the quoted limitations of microperc needle access for miniaturised PCNL, making this a versatile, safe and efficacious technique even in large and complex stones. A multi centre trial will be the best way to validate the suggestions proposed in this article.

The retrospective experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy.

BackgroundTo retrospectively assess the experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy (UMP) for the treatment of kidney stones by experienced surgeons.MethodsClinical data of 358 patients with kidney stones (254 males and 104 females; mean age: 59.60±11.70) who were performed UMP surgery in Shanghai Jiao Tong University School of Medicine affiliated Renji Hospital from June 2015 to December 2018. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery UMP was defined as discharge of patients either the same day or within 24 h after surgery. Semi tubeless UMP was defined as no placement of DJ and nephrostomy tube after surgery.ResultsThe average size of stones was 14.56±6.24 mm (range, 4–30 mm). There are solitary stones in 192 cases, multiple stones in 142 cases and 29 cases with Staghorn stones. F13 outer sheath was used for all operations; 358 patients completed UMP on the day of admission; 326 (91.06%) patients achieved same-day discharge or received overnight observation prior to discharge, and 32 patients (8.94%) required full admission (longer than 24 h). The readmission rate was 0.56% (2 patients). The postoperative complications within 1 week occurred in 36 (10.06%) patients, including 23, 10, 3 of grades I, II, IIIa complications (Clavien-System). The average operation time was 29.64 min and the hemoglobin drop were 13.42±9.55 g/L. The stone clearance rate was 91.62% (328/358). The semi tubeless rate war 95.25% (341/358).ConclusionsFor day-surgery semi tubeless UMP, experienced surgeons gain excellent patient outcomes in appropriately selected patients. Day-surgery semi tubeless UMP is worth promoting.

Ultra-mini flexible percutaneous nephrolithotomy in the treatment of moderate-size kidney stones: a new instrument, a preliminary prospective study.

Ultra-mini PNL is increasingly preferred in the treatment of kidney stones. Unlike routine applications of the ultra-mini PNL technique, we aimed to perform kidney stones treatment with an epiduroscopic device that can pass through 11-13-Fr ureteral access sheaths with a flexible structure and which is routine in neurosurgical practice. The study was planned prospectively. The study included 52 patients with mid-sized kidney stones who had presented to our clinic between July 2017 and January 2019. The ultra-mini percutaneous nephrolithotomy was carried out with epiduroscopy routinely used in neurosurgery practice, which can pass through 11-13-Fr ureteral access and has a flexible structure. The perioperative and postoperative parameters were analyzed. The mean operation time was 45.6 ± 4.8min and entry was provided through a single entry (from the calyx appropriate to the lower pole) in all patients; a second entry tract was not required. No DJ catheter or nephrostomy tube was installed in any patient and the procedures were completed totally without a tube. The mean reduction in hemoglobin values was determined as 0.33 (0.1-1.1) g/dL. None of the patients needed transfusion and no patient developed acute kidney injury. Clinically significant (≥ 3mm) residual stone was observed in 2 (4%) of the 52 patients, while clinically insignificant (≤ 3mm) stones were observed in 50 patients (96%). The mean length of hospital stay was 2.5 ± 0.9days. Ultra-mini flexible percutaneous nephrolithotomy is an effective and safe method in the treatment of medium-sized kidney stones.