Treatment of upper urinary calculi with Chinese minimally invasive percutaneous nephrolithotomy: a single-center experience with 12,482 consecutive patients over 20 years

Abstract

The Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) was a modified version of standard PCNL which utilizes smaller tract and sheaths. The aim of this study was to present our experience on its efficacy and safety, and to grade its complications according to the modified Clavien classification. Between 1992 and 2011, 12,482 patients who underwent 13,984 MPCNL procedures entered this study. Data on stone size, access number, operative time, hospital length of stay, stone-free rate (SFR), and complications according to the modified clavien system were evaluated prospectively. Their mean age of patients was 47.6 years (range 0.6-93). The mean stone size was 3.2 ± 0.8 (1.4-7.4) cm. The mean operative time was 83 ± 38 min. Mean hemoglobin drop was 13.5 ± 11.3 g/L. Mean hospital stay was 10.3 ± 6.4 days (2-22 days). The initial SFR after first procedure was 78.6 %. In 14.7 % of cases with a second look, the SFR increase to 89.9 %. At 3 months after auxiliary procedures (re-PCNL, ureterorenoscopy, and shock wave lithotripsy), the overall SFR was achieved to 94.8 %. A total of 3,624 complications (25.92 %) were observed in 2,591 (18.53 %) procedures. There were 2,355 grade I (16.84 %), 706 grade II (5.05 %), 553 grade III (3.95 %), 7 grade IV (0.05 %), and three death of grade V (0.02 %) complications. This large-scale, contemporary analysis confirms MPCNL is still a safe and efficacious treatment option of kidney stones with a high stone-free rate and uncommon rate of high grade complications.

A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy

“…PCNLs were performed by three experienced laparoscopic surgeons using the Chinese method of minimally invasive percutaneous nephrolithotomy [5][6][7]. However, these surgeons did not participate in this retrospective study.…”

Risk Factors for Postoperative Complications of Percutaneous Nephrolithotomy at a Tertiary Referral Center

“…[2][3][4][5][6] Unfortunately, only a few published reports used a specific complication score for urological surgery. 7,8,9 Moreover, until recently, there was a lack of standardization of PCNL reported outcomes. 10 For the past decade the modified Clavien classification has been widely used to categorize and report complications in surgical procedures.…”

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

“…That study analyzed stones between one to two centimeters and all stones were located in renal pelvis or one isolated calyx. Zeng et al [16] achieved a 71% stone-free rate after 12482 cases of mPNL, but the stone-free rate was 66.4% for complex stones. We have achieved a 92.5% success rate, and the mean stone burden of our patients was 22.8 mm 2 .…”