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

Abstract

Percutaneous nephrolithotomy (PCNL) is the treatment modality for renal stones > 20 mm recommended by the European Association of Urology and by the American Urological Association (1, 2). Sepsis and bleeding are among the most feared complications of PCNL and perhaps one of the causes for this surgery represents less than 5% of all kidney stone treatment modalities in Brazil and in the World (3, 4). Also, standard 30 Fr PCNL may cause infundibular strictures in the entry calyx (5). Attempts to minimize bleeding during PCNL led to technique modifications including reducing the percutaneous tract size to decrease the area of parenchymal and infundibular injury (6, 7).Percutaneous tract miniaturization evolved to several different techniques according to tract size. Indications for each technique vary according to stone size. Micro-PCNL (4.8-10 Fr) is more appropriate for kidney stones up to 15 mm, ultramini-PCNL (11-13 Fr) suits best for kidney stones up to 20 mm. However, there is no clear consensus about which tract size is best for kidney stones > 20 mm (8).The systematic review and meta-analysis conducted by Qin et al compared the efficacy and safety of mini (16-20 Fr) versus standard (24-30 Fr) percutaneous nephrolithotomy for renal stones more than 2 cm (9). Authors included seven randomized controlled trials in their meta-analysis, involving 1407 mini-

Antibiotic prophylaxis in urologic interventions: Who, when, where?

“…The impact of therapy duration was not assessed and in the included studies the duration varied too much. 90 Danilovic et al 91 showed in a recent meta-analysis that a one-week preoperative cycle of oral antibiotics was a protective factor from developing SIRS/sepsis [OR = 0.37, 95% CI 0.23-0.53]. Patients who received preoperative antibiotic therapy had lower positive intraoperative urine culture and stone culture than the control group.…”