Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi

Abstract

There has been continuing controversy regarding multiple tracts in a percutaneous nephrolithotomy (PCNL) session that may bring more complications, especially severe bleeding need for transfusion, even nephrectomy. Little tracts may bring less trauma to renal parenchyma than standard PCNL tracts. We carried minimally invasive PCNL (MPCNL) in treating staghorn calculi with multiple 16Fr percutaneous tracts in a single session, in an attempt to get high stone free with little trauma, and compared the morbidity of standard PCNL procedures in a prospective trial. A total of 54 consecutive patients with staghorn calculi were prospectively randomized for MPCNL (29) and PCNL (25). The size and location of stone, operative parameters, number of tracts, stone-free rate, operating time, hospital stay and complications were analyzed. In MPCNL group, a total of 67 percutaneous tracts were established in 29 renal units, while 28 tracts in 25 renal units in PCNL group. Compared to PCNL, MPCNL was associated with higher clearance rate (89.7 vs. 68%, p = 0.049), less chance need for adjunctive procedure of SWL or second-look PCNL (24.1 vs. 60%, p = 0.007), while a similar complication rate (37.9 vs. 52%, p = 0.300). In conclusion, with the development of instruments and increased experience, judiciously made multiple percutaneous tracts in a single session of MPCNL for treating staghorn calculi were safe, feasible and efficient with an acceptable morbidity.

Comparison of Percutaneous Nephrolithotomy, Shock Wave Lithotripsy, and Retrograde Intrarenal Surgery for Lower Pole Renal Calculi 10-20 mm

“…There are several publications on mini or micro PCNL for the treatment of kidney stones [22,23,24]. Our study reveals the clear advantage of PCNL for the treatment of kidney stones, but with considerably higher complication rates.…”

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

“…Nevertheless, it had similar complications yet a better stone clearance rate. 7 Aron and coworkers 17 also reported that PCNL monotherapy using multiple tracts is safe and effective and had an initial SFR of 84%. It could be the first-line option for staghorn renal calculi.…”

“…3 In 1998, we consolidated the procedure into a single stage and have since used this technique for all stones. [4][5][6][7] Large and complex stones constitute advanced calculus disease. The management strategy depends on the stone burden and their locations in the collecting system.…”

Ultrasonography-Guided Percutaneous Nephrolithotomy for the Treatment of Kidney Stone

“…Advancements in MPCNL equipment and techniques have helped broaden the indication of MPCNL to any UTUL requiring PCNL intervention, as suggested by Guangzhou and colleagues [15]. Using multiple tracts, MPCNL allows for the removal of staghorn calculi or complex renal calculi [16].…”

“…However, this forceful pulse flow raises a safety concern that the high intrapelvic pressure in MPCNL may cause backflow into the collecting system via vascular, lymphatic, and mesenchymal routes, and further subject patients to a higher risk of urosepsis [16]. In contrast to this concern, some suggest that MPCNL is safe, as the renal pelvic pressure remains lower than 30 mmHg, a pressure that usually leads to backflow.…”