Prospective comparative study of Miniperc and standard PNL for treatment of 1 to 2 cm size renal stone

Abstract

RESULTS• Mean tract size was 18.2 ± 2 F (15-20) and 26.8 ± 2 F (24-30), P value < 0.0001 in the miniperc and standard PNL, respectively. Holmium LASER and pneumatic lithotripter were the main energy sources used in miniperc and standard PNL, respectively.• Miniperc operative time was longer than that of standard PNL (45.2 ± 12.6 vs 31 ± 16.6 min, P = 0.0008 respectively).• Conversely, there was an advantage of miniperc over standard PNL in terms of a significantly reduced hemoglobin drop (0.8 ± 0.9 vs 1.3 ± 0.4 gram%, P = 0.01), analgesic requirement (55.4 ± 50 vs 70.2 ± 52 mg tramadol, P = 0.29) and hospital stay (3.2 ± 0.8 vs 4.8 ± 0.6 days, P ≤ 0.001), respectively.• Intra-operative conversion of the procedure into a tubeless PNL was significantly more in the miniperc group ( P ≤ 0.001). The miniperc and standard PNL group had clearance rates of 96% and 100%, respectively at 1 month follow up. CONCLUSIONS• This study demonstrated significant advantages of the miniperc procedure in terms of reduced bleeding leading to a tubeless procedure and reduced hospital stay.• The stone free rates and the complications were similar in either group. What's known on the subject? and What does the study add? Standard PNL is known to have higher clearance rates for stones 1-2 cm. However, it is not promoted because of its associated morbidity, especially bleeding. Minitiarization of the PNL has spawned a new interest in this modality for treating small bulk urolithiasis. KEYWORDSThe study adds to a growing body of evidence in a prospective manner that smaller tract PNL "miniperc" is associated with a similiar efficacy of achieving stone-clearance rates while decreasing the invasiveness of the procedure and associated morbidity. OBJECTIVE

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

“…However, some concerns about smaller caliber tracts and instruments such as impaired vision, increased operative time and lower stone-free status have been reported. [14] Mishra et al [15] demonstrated a 96% success rate with mPNL, similar with our stone-free rates. That study analyzed stones between one to two centimeters and all stones were located in renal pelvis or one isolated calyx.…”

Micropercutaneous Nephrolithotomy: First 66 Cases Experience

“…To address this, the diameter of the tool was decreased; mini-PNL, using needles with sizes of 12-20 Fr, was developed (17). It has been demonstrated that compared to standard PNL, mini-PNL results in lower hemorrhage rates and shorter hospital stays (11,18). Furthermore, Bader et al (13) have provided a reliable and effective method for direct entry into kidney stones under direct vision by means of an "all-seeing needle," which is the optical imaging system with the smallest diameter.…”

“…Therefore, to avoid wide dilation and to reduce trauma, the development of fine instruments is required. In particular, retrograde intrarenal surgery (RIRC) and mini-PNL methods are currently being used to minimize damage to renal parenchyma during treatment of cases in which shock wave lithotripsy (SWL) failed to treat small-scale pole stones (11,12).…”

Mikroperkütan nefrolitotomi sonrasıı gelişen renal psödoanevrizma

“…The interest in reducing the tract size was to potentially reduce the invasiveness of the procedure and, therefore, attending complications. Three prospective comparative studies addressed the issues of efficacy and enhanced safety of reducing the tract size [6][7][8] .…”