Tract Sizes in Miniaturized Percutaneous Nephrolithotomy: A Systematic Review from the European Association of Urology Urolithiasis Guidelines Panel

Ruhayel, Yasir; Tepeler, Abdülkadir; Dabestani, Saeed; MacLennan, Steven; Petřík, Aleš; Sarıca, Kemal; Seitz, Christian; Skolarikos, Andreas; Straub, Michael; Türk, Christian; Yuan, Yuhong; Knoll, Thomas

doi:10.1016/j.eururo.2017.01.046

Cited by 134 publications

(79 citation statements)

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“…The complication rate of standard PCNL was reported to be 15.9%, whereas that of minimally invasive PCNL was reported to be 12.8% The complication rate of PCNL improved from 21.3% between 1997 and 2005 to 10.3% between 2006 and 2014 The most common postoperative complications associated with PCNL are fever and bleeding, urinary leakage, and problems due to residual stones (LE:1; Table ) Clavien 1, 2, 3, 4 and 5 complications were observed in 88.1%, 7%, 4.1%, 0.6% and 0.04% of cases, respectively . One RCT has compared ECIRS with minimally invasive PCNL, and showed that no significant difference in perioperative complications including blood transfusion was observed between the two groups ( P = 0.409; LE:2)…”

Section: Clinical Questions and Answersmentioning

confidence: 99%

“…The complication rate of standard PCNL was reported to be 15.9%, whereas that of minimally invasive PCNL was reported to be 12.8% (LE:1). 162,163 The complication rate of PCNL improved from 21.3% between 1997 and 2005 to 10.3% between 2006 and 2014 (LE:3). 164 The most common postoperative complications associated with PCNL are fever and bleeding, urinary leakage, and problems due to residual stones (LE:1; Table 6).…”

Section: Commentarymentioning

confidence: 99%

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The Urological Association of Asia clinical guideline for urinary stone disease

Taguchi

Cho

et al. 2019

Int J of Urology

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The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues.

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Section: Clinical Questions and Answersmentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

The Urological Association of Asia clinical guideline for urinary stone disease

Taguchi

Cho

et al. 2019

Int J of Urology

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“…However, a large tract has the disadvantages of more renal trauma and more bleeding. Currently, there is a trend toward using a smaller NS, the MPCNL [6], to decrease the risk of renal injury and bleeding [7]. However, with the reduction in size of the NS there is a potential of concomitant increase in the RPP [8].…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones

Liang

et al. 2020

BJU International

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are first co-authors and contributed equally to this work. ObjectiveTo compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. Patients and MethodsA prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. ResultsThe patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. ConclusionUsing SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.

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“…Although the advantage of high stone clearance rates has been widely proved in reports, the invasive method with serious complications might also worry urologists inevitably. At the same time, RIRS has been recommend as the rst-line treatment targeting intrarenal stones between 1-2 cm, in particular, for patients of obesity, anticoagulation, skeletal deformity and renal anomalies, the indications of RIRS could be broaden [12][13][14]11].…”

Section: Correlation Analysismentioning

confidence: 99%

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

Wang

et al. 2020

Preprint

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Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are both important minimally invasive techniques for the treatment of renal stones. With the progress of technology, the application of procedures has been extended. Current surgery choices are made base on stone size, burden and its locations that might limit the predictability and removal of post-operative residual stones. Despite these surgery techniques are maturely used in clinical practice, the patients’ selection have not been standardized in borderline stone. Some patients might suffer several sessions of surgery if intervene decision are not well-designed. In this single-center study, we aimed to determine whether the Hounsfield Unit (HU) value of no-contrast computer computed tomography (NCCT) might offer better guidance in the selection of RIRS or PCNL in renal stones of 2-3 cm, not only in facilitating the stone disintegration, also in providing the potential optimal and less session of setting with great outcomes. A total of 158 patients with kidney stones (2-3 cm) who underwent PCNL/RIRS from March 2016 to January 2019 were enrolled in this study. Gender, stone sizes, locations, average HU value of stone, surgery time, hospital stay time, stone free rate and complications at the time of hospitalization and 3 month follow-up were measured to identify the surgery efficiency. Upon consideration of HU value, the mean surgery time were significantly decreased in RIRS comparing to cRIRS group (47.73 ± 15.52 versus 72.41 ± 27.71 min, p<0.05). Statistically, the surgery time was strong influenced by the HU values both in RIRS (OR: 93.8, p<0.01) and PCNL (OR, 8.21, p<0.05). HU values proved to have a strong positive relation with surgery time in RIRS while a low positive related in PCNL (p<0.05). Overall, for renal stones of 2-3 cm, RIRS proved to be a safe and efficacious treatment option if HU value and other parameters could be comprehensively accounted. Considering HU value before 2-3cm kidney stone lithotripsy seems to be necessary, which might save the surgery time and reduce the potential risk of renal injury, as even if residual stone were detected post-op, ESWL could also be employed and work efficiently. Some patients might not have to perform several sessions of RIRS. Taken together, individual precision surgery might provide ideal treatment and prognosis for patients requiring long-term continuous clinical procedures.

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Tract Sizes in Miniaturized Percutaneous Nephrolithotomy: A Systematic Review from the European Association of Urology Urolithiasis Guidelines Panel

Abstract: Removing kidney stones via percutaneous nephrolithotomy (PNL) using smaller sized instruments (mini-PNL) appears to be as effective and safe as using larger (traditional) instruments, but more clinical research is needed.

Cited by 134 publications

References 55 publications

The Urological Association of Asia clinical guideline for urinary stone disease

The Urological Association of Asia clinical guideline for urinary stone disease

Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

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