Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones

Abstract

are first co-authors and contributed equally to this work. ObjectiveTo compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. Patients and MethodsA prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. ResultsThe patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. ConclusionUsing SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.

Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis

“…Three studies containing operative time data [ 15 , 16 ] were analyzed, and the results indicated that the operative time of the vacuum-assisted sheath group was significantly reduced compared to that of the conventional sheath group (MD = − 15.74; 95% CI − 1944, − 12.04, P < 0.00001), with insignificant heterogeneity (I 2 = 0%, P = 0.91) (Fig. 5 ).…”

“…Xu et al reported a higher incidence of postoperative fever [ 15 ]. Due to the small size of the sheath, high-pressure perfusion is very often performed.…”

“…Du et al found that MPCNL with a vacuum sheath has a low intrapelvic pressure compared to standard PCNL and MPCNL [ 14 ]. Xu et al found that intrapelvic pressure ≥ 30 mmHg was achieved in the non-vacuum-sheath group [ 15 ].…”

Current evidence for suction in endourological procedures: comprehensive review of literature

“…Moreover, Xu et al prospectively randomized 66 patients with staghorn stones to suctioning MPCNL using the ClearPetra sheath and nonsuctioning traditional MPCNL. They reported 86.7% SFR in the suctioning group compared with 70% in the traditional MPCNL [17] (Table 1).…”

One-stage efficacy of single tract minimally invasive ECIRS in the improved prone frog split-leg position for staghorn stones

“…However, the high stone-free rate (SFR) of PNL often needs to establish multiple access tracts, and the increased number of tracts is the risk factor for postoperative complications, especially bleeding [ 3 , 4 ]. Minimally invasive PNL (mPNL) use the size of 16F to 20F tract sheath [ 5 ], which has advantages of lower postoperative bleeding rate and similar SFR [ 6 , 7 ], but a disadvantage of lower intraoperative therapeutic efficiency [ 8 ]. With the rapid development of endoscopic equipment, flexible ureteroscope (FURS) has been accepted by most urologists to treat renal stones < 2 cm [ 2 , 9 ], Even for some stones ≥ 2 cm [ 10 , 11 ].…”