Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Abstract

AbstractsPurpose: To determine whether minimally invasive PCNL (MPCNL) is as safe and effective in the management of complex renal caliceal stones as it is for simple renal stones. Patients and Methods: We retrospectively reviewed 5761(41.2%) simple caliceal stones (isolated renal pelvis including isolated calix) and 8223 (58.8%) complex caliceal stones (renal pelvis accompanying two calices at least) that were managed by MPCNL between 1992 nd 2011. The safety, efficacy, and outcome were compared and analyzed. Results: Stone burden was larger in complex caliceal stones (1763.0 vs 1018.6 mm 2 , P < 0.05). Patients with simple stones had significantly shorter operative time, less frequency of multiple percutaneous accesses, and less hemoglobin drop. They also had a higher initial stone-free rate (SFR) (77.6% vs 66.4%) after a single session of MPCNL (P < 0.05). The differences diminished in the final SFR (86.7% vs 86.1%) after relook and/or auxiliary procedures (P > 0.05). The complication rate (17.9% vs 19.0%) and blood transfusion rate (grade II) (2.2% vs 3.2%) were similar in both groups (P > 0.05). Both groups had a low rate of high Clavien grade complications. Renal vascular embolizations (grade III), however, were significantly higher in patients with complex caliceal stones (P < 0.05). Conclusions: MPCNL is a safe and effective treatment option for patients with complex caliceal stones except there is a slightly higher frequency rate of embolization. There was a higher initial SFR in simple stones, but this difference diminished with secondary procedures.

The optimal minimally invasive percutaneous nephrolithotomy strategy for the treatment of staghorn stones in a solitary kidney

“…We had previously reported that MPCNL is a safe and effective therapeutic modality for this condition [1]. Nevertheless, using MPCNL in the management of staghorn stones is technically complicated, time consuming, and taxing to both the patients and the surgeons.…”

Supine or prone position for mini-PNL procedure: does it matter

“…Reports of MPNL use in adults with a specially designed mini-nephroscope were published in 2001 [4]. Later on results in the adult population evolved with comparable success rates [5].…”

Predicting Outcomes after Minimally Percutaneous Nephrolithotomy with the Aid of a Patented System by Using the Guy's Stone Score

“…The success and complication rates in PCNL can vary according to the complexity of stone disease [12,13]. Calculi were commonly classified into simple or complex, pelvic or calyceal based on location, or single or multiple.…”