The role of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS)

Abstract

To assess the safety and efficacy of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS), we retrospectively evaluated 44 patients with symptomatic LPSs with previously failed SWL or RIRS and consequently underwent SMP from October 2014 to March 2016. The percutaneous renal access was performed 12-14F with C-arm fluoroscopy or ultrasonographic guidance. Stone disintegration was performed using either Holmium laser or pneumatic lithotripter. Perioperative parameters along with operations were assessed in detail. A total of 44 patients (mean age 49.1 ± 13.7 years) were included in the study. Stone size was 18.4 ± 6.0 mm (range 9-29), operative time was 63.9 ± 32.7 min (range 14-145) and hospital stay was 2.8 ± 1.2 days (range 1-5). The hemoglobin drop was 12.4 ± 8.8 g/L (range 0-31), and no patients required blood transfusion. Complete stone-free status was achieved in 40 (90.9%) patients. Clinically insignificant residual fragments were observed in three (6.8%) patients and only one (2.3%) patient had a 6 mm residual calculus. A total of three minor complications (urinary tract infection, hemorrhage resolved by hemostatics and renal colic requiring analgesics) were observed postoperatively. For symptomatic LPSs after the failure of SWL or RIRS, SMP is a safe and efficient auxiliary option and even might be an alternative to SWL or RIRS, while further considering the stone-free rates and stone-related events.

Neurogenic Bladder-Induced Stone in a Pelvic Kidney of a Caudal Regression Syndrome Patient: Management of a Complex Case

“…The ectopic pelvic kidney, which is positioned anterior to the sacrum and in the retroperitoneum, connects bowel loops between the pelvic kidney and the anterior abdominal wall. A blind percutaneous transperitoneal route to a pelvic kidney should be avoided because of the considerable risk of colon damage [11][12][13][14].…”

Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction

“…Nephrostomy/JJ ureteral stent was kept for patients with gross hydronephrosis requiring postoperative drainage, if there was intra-operative bleeding or if there was doubt of residual fragments left behind. [23] 311 100 W holmium 56 81.03 NA X-ray KUB (days 3-5), NCCT (when necessary) Zeng et al [10] 80 8-20 W holmium 52.3 91.2 93.8 X-ray KUB and USG (day 1) NCCT (3 months) Fan et al [26] 44 Pneumatic/Laser 63.9 90.9 NA X-ray KUB/NCCT (day 1 and at 3 months if required) Cai et al [28] 188 Pneumatic/holmium 35 84 91.5 X-ray KUB and USG (< day 2) NCCT (3 months) Liu et al [27] 73 Further multi-institutional randomized controlled trials are warranted to support the findings we have observed.…”

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis

“…Recently, several studies were performed to compare the safety and efficacy of SMP with other mini-PCNL techniques [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Guddeti et al performed a randomized clinical trial (RCT) to evaluate the efficacy of SMP versus standard PCNL in the management of renal calculi (<2 cm).…”