Comparison of miniaturized percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for the treatment of large kidney stones: a randomized prospective study

Abstract

We aimed to compare the outcomes of mini-percutaneous nephrolithotomy (mPNL) and standard PNL techniques in the treatment of renal stones ≥ 2 cm. The study was designed as a randomized prospective study between January 2016 and April 2017. The patients with a kidney stone ≥ 2 cm were included in the study. Patients who had uncorrectable bleeding diathesis, abnormal renal anatomy, skeletal tract abnormalities, pregnant patients and pediatric patients (< 18 years old) were excluded from the study. The remaining patients were randomly divided into two groups as standard PNL and mPNL. For both group, demographic data, stone characteristics, operative data and postoperative data were recorded prospectively. The study included 160 consecutive patients who had kidney stone ≥ 2 cm. Of these, patients who met the exclusion criteria and patients who had missing data were excluded from the study. Remaining 97 patients were randomly divided into two groups as mPNL (n: 46) and standard PNL (n: 51). The mean age was 46.9 ± 13.7 and 47.4 ± 13.9 years for mPNL group and sPNL group, respectively. According to Clavien-Dindo classification, no statistical difference was detected between the groups in terms of complication rates (p 0.31). However, the rates of hemoglobin drop and transfusion rates were significantly in favour of mPNL (p 0.012 and p 0.018, respectively). Nephrostomy time and hospitalization time was found to be significantly shorter in mPNL group (p 0.017 and p 0.01, respectively). The success rate in the mPCNL group was higher than standard PNL group, however, this difference was statistically insignificant (76.5 vs 71.7%, p 0.59). Both mPNL and standard PNL are safe and effective treatment techniques for the treatment of kidney stones of ≥ 2 cm. Although there was no significant difference in success rates of both techniques; nephrostomy time, hospitalization time, bleeding and transfusion rates were in favour of mPNL.

The efficacy and safety of miniaturized percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials

“…evaluated the study quality ( Fig. 1) according to the Cochrane Collaboration's Risk of Bias tool in the Review Manager software (https://community.cochrane.org/help/tools-and-software/revman-5) [4,[7][8][9][10][11][12][13][14]. This tool primarily evaluates seven domains: random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other bias (such as funding sources).…”

“…In this scenario, Jackman et al [3] first proposed the concept and technique of miniaturized PCNL (mPCNL), which is defined as the procedure conducted by forming a ≤22 Fr nephrostomy tract [1]. In recent years, modifications of PCNL have continued with the introduction of micro-PCNL, ultra-mPCNL, and super mPCNL techniques [4].…”

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

“…The mini PCNL procedures with suction were also faster than the standard PCNLs. In another investigation, mini PCNL using laser disintegration was compared with standard PCNL using combined ballistic and ultrasonic lithotripsy for stones larger than 2 cm, and both techniques were found to be equally effective, regardless of whether the patients had a single stone or multiple calyceal stones [25].…”

Updates in endourological management of urolithiasis

“…Currently, there are at least two nomenclature for PCNL tract size, which might lead to confusion (Table ) . Although the stone clearance rate is good with the standard PCNL, mini‐PCNL has been shown to have less blood loss, reduced hospital stay and more tubeless procedures without compromising the stone clearance rate or increasing the infective complications . However, there are controversies on whether procedure time is prolonged .…”

“…67,68 Although the stone clearance rate is good with the standard PCNL, mini-PCNL has been shown to have less blood loss, reduced hospital stay and more tubeless procedures without compromising the stone clearance rate or increasing the infective complications. [69][70][71][72] However, there are controversies on whether procedure time is prolonged. 69,70 The use of multiple tracts with mini-PCNL for treating staghorn stones has also been shown, and it was noted that the use of multiple mini-PCNL tracts is associated with a higher clearance rate with a similar complication rate.…”