Ultra-mini-percutaneous nephrolithotomy (PCNL) versus standard PCNL: A randomised clinical trial

Haghighi, Ramin; Zeraati, Hossein; Zade, Maryam Ghorban

doi:10.1016/j.aju.2017.10.003

Cited by 44 publications

(40 citation statements)

References 17 publications

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“…[179][180][181][182] Miniaturized PCNL can be considered when there are diverticular stones, and pediatric medium-sized stones as well (LE:4). 179,180,183 Miniaturized PCNL has shown comparable surgical outcomes to conventional PCNL in terms of SFRs with lower probability of complications; 184,185 however, it seems to have longer operative times and higher intrarenal pressure than conventional PCNL during surgery. 186,187 The surgical outcomes of miniaturized PCNL are promising, with good SFRs, shorter hospital stay and reduced risk of morbidity, such as bleeding, adjacent organ injury and so on (LE:1).…”

Section: Commentarymentioning

confidence: 99%

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The Urological Association of Asia clinical guideline for urinary stone disease

et al. 2019

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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: Commentarymentioning

confidence: 99%

“…The summarized flow chart for treatment algorithm is shown in Figure 3. 166,[174][175][176][177][178][179][180][181]184,185,188,189,[191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206]. What is an algorithm for treatment of adult patients with ureteral stones?…”

Section: Commentarymentioning

confidence: 99%

The Urological Association of Asia clinical guideline for urinary stone disease

et al. 2019

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“…evaluated the study quality ( Fig. 1) according to the Cochrane Collaboration's Risk of Bias tool in the Review Manager software (https://community.cochrane.org/help/tools-and-software/revman-5) [4,[7][8][9][10][11][12][13][14]. This tool primarily evaluates seven domains: random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other bias (such as funding sources).…”

Section: Quality Assessmentmentioning

confidence: 99%

“…In addition, the hemoglobin drop was lower in the mPCNL group (MD, -0.72; 95% CI, -1.04 to -0.40; p<0.00001) with moderate heterogeneity between the trials (I 2 =68%). The trial of Haghighi et al [12] seemed to be the source of the heterogeneity. The hemoglobin drop was still lower in the mPCNL group (MD, -0.53; 95% CI, -0.71 to -0.36; p<0.00001) after the exclusion of this study, which resulted in no heterogeneity between trials (I 2 =0%).…”

Section: Primary Outcomesmentioning

confidence: 99%

The efficacy and safety of miniaturized percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials

Feng

Tang

et al. 2020

Investig Clin Urol

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Purpose: Our aim was to assess the efficacy and safety of miniaturized percutaneous nephrolithotomy (mPCNL) versus standard PCNL (sPCNL) to provide higher-level evidence. Materials and Methods: Eligible randomized controlled trials were identified from electronic databases. The data analysis was performed by the Cochrane Collaboration's software RevMan 5.3. Results: A total of 1,219 patients from 9 articles published between 2004 and 2019 were included. Compared with those who received sPCNL, patients who received mPCNL experienced a higher stone-free rate (SFR) (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.99; p=0.03), lower transfusion rates (OR, 0.33; 95% CI, 0.17-0.63; p=0.0007), and lower drops in hemoglobin (mean difference [MD],-0.72; 95% CI,-1.04 to-0.40; p<0.00001), but the operative time seemed to be significantly longer (MD, 10.98; 95% CI, 3.64-18.32; p=0.003). Of note, there was no significant difference between the two groups regarding the SFR (p=0.09) for renal calculi ≥2 cm. In addition, the meta-analysis results showed no significant differences between the groups regarding urine leakage (p=0.60), postoperative fever (p=0.71), impaired ventilation (p=0.97), or total complications (p=0.29) with no heterogeneity between trials. These results remain unaffected with regard to renal calculi ≥2 cm. Conclusions: Our findings suggested that mPCNL had a higher SFR than sPCNL and there was no significant difference between the two groups for renal stones ≥2 cm. Besides, mPCNL tended to be associated with significantly less bleeding and a lower transfusion rate, but the duration of the procedure seemed to be significantly longer.

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“…A large number of studies have found that the mechanism of sepsis after MPCNL mainly includes two aspects: urinary tract infection and an excessively high intrapelvic pressure, which cause bacteria and associated toxins to enter the blood stream via the renal pelvis vein and the lymph, resulting in urosepsis [24,25]. Additionally, a study comparing PCNL via a minimally invasive technology with a standard channel demonstrated that for complex renal and infectious stones, the larger the surgical channel, the lower the sepsis incidence [26][27][28]. Larger channels could be implemented in patients with potential UTI or a large stone load, in order to reduce the renal pelvic pressure and prevent sepsis.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection

Wang

Yuan

Peng

et al. 2020

BioMed Research International

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The purpose of this study was to assess risk factors of urosepsis after minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of upper urinary tract stones in patients with preoperative urinary tract infection (UTI) and to explore preventive measures. Between 2008 and 2016, patients with preoperative UTI who underwent MPCNL for upper urinary tract stones were retrospectively collected. Patients were divided into nonurosepsis and urosepsis groups. Perioperative outcomes of all patients were evaluated and compared between the two groups. Risk factors for post-MPCNL urosepsis were investigated using univariate and multivariate regression analysis. A total of 843 patients including 22 patients with postoperative urosepsis (urosepsis group) and 821 patients without urosepsis (nonurosepsis group) were finally included in this study. All patients with postoperative urosepsis were cured and discharged after treatment. In univariate analysis it was demonstrated that the incidence of urosepsis after MPCNL was significantly correlated with channel size (P=0.001), surgical time (P=0.003), as well as the tear of the collection system and percutaneous renal channel crossing the renal papilla (P=0.004). Moreover, multivariate analysis showed that smaller channel size (OR = 11.192, 95% CI: 2.425–51.650, P=0.002), longer surgical time (OR = 6.762, 95% CI: 1.712–17.844, P=0.008), and tear of collection system and percutaneous renal channel crossing the renal papilla (OR = 5.531, 95% CI 1.228–14.469, P=0.012) were independent risk factors for urosepsis following MPCNL in patients with preoperative UTI. In conclusion, in patients with preoperative UTI undergoing MPCNL for upper urinary tract stones, smaller channel size, prolonged operation time, as well as tear of the collection system and percutaneous renal channel crossing the renal papilla are independent risk factors for postoperative urosepsis. Therefore, it is indicated that, in clinical practice, it is of great significance to choose appropriate channel size and avoid renal injury and control surgical time to prevent the urosepsis after MPCNL in patients with preoperative UTI.

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Ultra-mini-percutaneous nephrolithotomy (PCNL) versus standard PCNL: A randomised clinical trial

Cited by 44 publications

References 17 publications

The Urological Association of Asia clinical guideline for urinary stone disease

The Urological Association of Asia clinical guideline for urinary stone disease

The efficacy and safety of miniaturized percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection

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