Safety and efficacy of a single middle calyx access (MCA) in mini-PCNL

Khadgi, Sanjay; El-Nahas, Ahmed R.; Darrad, Maitrey; Al‐Terki, Abdullatif

doi:10.1007/s00240-019-01176-4

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…It is commonly known, the access via the upper pole of the kidney most often corresponds to access in the intercostal space, where the risk of pleural injuries increases compared to subcostal access. A number of studies note a significant reduction of pleural injuries during puncture and dilatation of the kidney to a smaller diameter tract [24,25]. In our study, in neither of the groups studied, pleural injuries or injuries of abdominal organs were noted.…”

contrasting

confidence: 59%

Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

Sahalevych

Sergiychuk

Ozhohin

et al. 2021

Ukr. J. Nephrol. and Dial.

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Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p<0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p<0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p<0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p<0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р<0.001. Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

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contrasting

confidence: 59%

Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

Sahalevych

Sergiychuk

Ozhohin

et al. 2021

Ukr. J. Nephrol. and Dial.

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“…Another factor was the need for multiple tracts in 70% of standard-PCNLs vs 35% of mini-PCNLs. This is attributed to the feasibility of navigation of most renal calyces by a small 12-F nephroscope through a single access without damage to the calyceal necks [ 22 ]. These manoeuvres would have caused severe bleeding from calyceal neck injury if tried with large 24-F nephroscope.…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] reported a SFR of 84% for two-stage multi-tract mini-PCNL for staghorn stones. These retrospective case series showed the safety and efficacy of this technique and encouraged more surgeons to perform mini-PCNL for the treatment of large, complex and staghorn stones [ 12 , 22 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of standard- and mini-percutaneous nephrolithotomy for staghorn stones

Khadgi¹,

El-Nahas

El-Shazly

et al. 2021

Arab Journal of Urology

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Objectives: To compare the outcomes of standard-and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18-20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P < 0.001). Conclusions:The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay.

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“…This interpolar renal access enabled accessibility to almost all the PCS and therefore allowing complete stone clearance without the need for multiple tracts in the majority of cases. [ 20 ] Recently, Lahme published outcomes of mini-PCNL for larger stones >5 cm 2 in 321 patients and reported a stone-free rate of 94.7%. [ 21 ] However, this was achieved after a retreatment rate of 38.7%.…”

Section: Discussionmentioning

confidence: 99%