Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

Abstract

The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11–20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.

Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study

“…[1,2] Initially, mini-PERC technique was first developed for children and reported by Helal et al [3] With growing evidence of decrease in morbidity from PCNL with reduction in tract size [4,5] the recent developments in PCNL is aimed towards creating a reduced tract size. This has led to the evolving of various minimally invasive PCNL (MIP) techniques.…”

A Usability Comparison of Laser Suction Handpieces for Percutaneous Nephrolithotomy

“…As higher power laser systems have been developed, investigators have determined that delivery of up to 70 watts of energy to a kidney stone at the time of PCNL is safe. 9 While use of laser lithotripsy during mini-, ultramini-and micro-PCNL has been described, [11][12][13] it is not commonly used at the time of standard PCNL. In one of the few studies on this topic, El-Nahas et al randomized patients undergoing PCNL to high-powered laser lithotripsy versus ultrasonic lithotripsy.…”

Current trends and pitfalls in endoscopic treatment of urolithiasis

“…The incidence of urolithiasis in Japan also has been increasing . In addition, urolithiasis is a highly recurrent disease, with a recurrence risk of 34–50% . Technological advancements have led to gradual introduction of new techniques for the treatment of urolithiasis, such as SWL, RIRS and PCNL.…”