Objective• To compare micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of renal calculi <1.5 cm with regard to stone clearance rates and surgical characteristics, complications and postoperative recovery. Patients and Methods• Seventy patients presenting with renal calculi <1.5 cm were equally randomized to a microperc or a RIRS group between February 2011 and August 2012 in this randomized controlled trial. Randomization was based on centralized computer-generated numbers. Patients and authors assessing the outcomes were not blinded to the procedure.• Microperc was performed using a 4. 85-F (16-gauge) needle with a 272-mm laser fibre. RIRS was performed using a uretero-renoscope.• Variables studied were stone clearance rates, operating time, need for JJ stenting, intra-operative and postoperative complications (according to the Clavien-Dindo classification system), surgeon discomfort score, postoperative pain score, analgesic requirement and hospital stay.• Stone clearance was assessed using ultrasonography and X-ray plain abdominal film of kidney, ureter and bladder at 3 months. Results• There were 35 patients in each group. All the patients were included in the final analysis.• The stone clearance rates in the microperc and RIRS groups were similar (97.1 vs 94.1%, P = 1.0).• The mean [SD] operating time was similar between the groups (51.6 [18.5] vs 47.1 [17.5], P = 0.295). JJ stenting was required in a lower proportion of patients in the microperc group (20 vs 62.8%, P < 0.001). Intra-operative complications were a minor pelvic perforation in one patient and transient haematuria in two patients, all in the microperc group. One patient in each group required conversion to miniperc. • One patient in the microperc group needed RIRS for small residual calculi 1 day after surgery. The decrease in haemoglobin was greater in the microperc group (0.96 vs 0.56 g/dL, P < 0.001). The incidence of postoperative fever (Clavien I) was similar in the two groups (8.6 vs 11.4%, P = 1.0). None of the patients in the study required blood transfusion. • The mean [SD] postoperative pain score at 24 h was slightly higher in the microperc group (1. Conclusions• Microperc is a safe and effective alternative to RIRS for the management of small renal calculi and has similar stone clearance and complication rates when compared to RIRS.• Microperc is associated with higher haemoglobin loss, increased pain and higher analgesic requirements, while RIRS is associated with a higher requirement for JJ stenting.
Study Type – Therapy (pattern of practice survey) Level of Evidence 2b What's known on the subject? and What does the study add? Miniperc and RIRS are commonly used modality for treating non‐bulky renal urolithiasis. Both the treatment options are invasive and are associated with inherent complications. There are only a few studies that compare these two treatment modalities. Both the modalities are effective to render patient stone free with minimal complications. Immediate stone free rate is higher with miniperc but comparable in both the modalities at 1 month. RIRS is associated with favourable pain scores and lower hemoglobin drop. OBJECTIVE To plan a prospective comparative case–control designed study aiming to compare minipercutaneous (miniperc) and retrograde intrarenal surgery (RIRS) for a renal calculus of size 1–2 cm. PATIENTS AND METHODS A total of 64 cases (32 in each arm) underwent miniperc and RIRS during the study period from March 2009 to April 2011. The primary and secondary outcome objective was stone‐free rate and retreatment rate, complications, operation duration, patient visual pain scores, analgesic requirement, haemoglobin drop and hospital stay, respectively. RESULTS Miniperc and RIRS had stone clearance rates of 100% and 96.88%, respectively. In the RIRS group, one patient required retreatment at 1 month. Hospital stay (0.24) and intra‐operative (0.99) and postoperative complications (0.60) were similar in both groups. Operation duration (P= 0.003) was lower in the miniperc group. Haemoglobin drop (P < 0.001), patient pain and visual analogue scale score (each P < 0.001) at 6, 24 and 48 h, as well as analgesic requirement (P < 0.003), were all lower in the RIRS group. CONCLUSIONS The stone clearances in both modalities are high and complications are low. RIRS requires a larger operation duration, although it is associated with favourable pain scores and a lower haemoglobin drop.
Delayed primary closure is a sound incision management technique that should be utilized for dirty abdominal incisions. It significantly lowers the rate of superficial SSI as well as fascial dehiscence and reduces the mean CIH time and hospitalization. The short-term cosmetic appearance is superior.
‘Microperc’ is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 16 G micropuncture needle. ‘Mini-microperc’ is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. The available evidence indicates that microperc is safe and efficient in the management of small renal calculi in adult and pediatric population. It can also be used for renal calculi in ectopic kidneys and bladder calculi. The high stone clearance rate and lower complication rate associated with microperc make it a viable alternative to retrograde intrarenal surgery.
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