Miniaturization of percutaneous nephrolithotomy Smaller, but better?

Huusmann, Stephan; Nagele, Udo; Herrmann, Thomas

doi:10.1097/mou.0000000000000375

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…This may have offset the advantage of microperc, which is intended to accomplish a totally tubeless kidney stone management procedure without a nephrostomy tube or double-J stent. 5,6,[13][14][15]21,40,41 However, some cases of >20.0 mm calculus that necessitate long operative times or result in more residual fragments are also indwelled with ureteral ste nts. 1,4,6,7,12,14,15,19,37,38 In addition, stent insertion can be required due to postoperative renal colic and steinstra sse.…”

Section: Discussionmentioning

confidence: 99%

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Zhang

Kang

Jiang

et al. 2021

Journal of Investigative Surgery

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Background: Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS). Methods: Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position. Results: Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively. Conclusions: Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.

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Section: Discussionmentioning

confidence: 99%

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Zhang

Kang

Jiang

et al. 2021

Journal of Investigative Surgery

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“…Grâce à la diminution du risque hémorragique et une bonne clairance des calculs, un nombre important de patients peut être laissé sans aucune méthode de drainage après l'opération (ni néphrostomie, ni pigtail). 9 Le confort du patient s'en trouve évidemment très amélioré et, surtout, cela permet de réduire de manière importante la durée du séjour hospitalier.…”

Section: éVolution Et Miniaturisationunclassified

Évolution et miniaturisation de la néphrolithotomie percutanée

Schoofs¹,

Celentano²,

Abboudi³

et al. 2019

Revue Médicale Suisse

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La néphrolithotomie percutanée (NLPC) était initialement indiquée pour les calculs rénaux de grande taille. Les progrès technologiques ont permis une amélioration significative du matériel disponible, principalement dans le sens de la miniaturisation des instruments. Ceci ne doit cependant pas se faire au détriment de la plus grande clairance possible des calculs. Une multitude de techniques sont apparues sur le marché dans l'optique de diminuer les complications possibles des NLPC, en particulier le risque hémorragique. L'invasivité de cette intervention étant réduite, ses indications s'en trouvent considérablement élargies et un nombre croissant de patients vont en bénéficier à l'avenir. Ceci explique l'intérêt de connaître un peu mieux cette technique chirurgicale en constante évolution. Evolution and miniaturization of percutaneous nephrolithotomyPercutaneous nephrolithotomy (PCNL) was at first indicated for larger renal stones. Technological progress allowed a significant improvement of the available equipment, mostly to miniaturize the devices. However, this should not affect the stone clearance. Many different techniques arised aiming to reduce the complications of PCNL, in particular the risk of haemorrhage. As it becomes less invasive, the indications are greatly expanded, and a growing number of patients will benefit from it in the future. This explains the significance of knowing this procedure in continual development in greater detail.

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“…For many years endourologists are searching for the most efficient and least traumatic stone treatment. More and more miniaturized instruments and innovative stone disintegration tools are continuously expanding our armamentarium [1,2]. Meanwhile, currently available modern imaging modalities are able to detect more and smaller residual fragments postoperatively.…”

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confidence: 99%