World Journal of Urology

, Volume 33, Issue 12, pp 2131–2136 | Cite as

Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10–35 mm

  • Konrad WilhelmEmail author
  • Simon Hein
  • Fabian Adams
  • Daniel Schlager
  • Arkadiusz Miernik
  • Martin Schoenthaler
Original Article



To compare ultra-mini PCNL (UMP) and flexible ureteroscopy (fURS) for the treatment of medium- to large-sized renal stones with a focus on patients’ postsurgical cumulative analgesic consumption and treatment-related satisfaction.


Twenty-five patients treated by UMP between April 2013 and October 2014 were matched to data of 25 fURS patients from an existing database. Clinical outcome parameters were recorded prospectively. Postoperative analgesic consumption was assessed using the Cumulative Analgesic Consumption Score (CACS), and satisfaction was measured with the Freiburg Index of Patient Satisfaction (FIPS) questionnaire.


Perioperative outcome parameters showed no significant differences except for mean operating times (fURS 98.52 min, UMP 130.12 min [p = 0.002]) and hospital stay (fURS 67.2 h, UMP 91.5 h [p = 0.04]). Primary stone-free rate was 96 % in fURS and 92 % in UMP. Complications Clavien grade 2 or 3 occurred in 16 % of UMP patients and in 4 % of fURS patients. Postsurgical cumulative analgesic consumption was almost identical in both groups with CACSs of 6.96 (0–15) for fURS and 6.8 (0–23) for UMP. Patients’ satisfaction was high in both techniques: FIPS score in fURS 1.67 (1–3) and 1.73 (1–4) in UMP (scale 1–6).


Treatment of medium- to large-sized renal stones is safe and highly effective by both UMP and fURS. Moreover, both treatments yield comparable postsurgical analgesic requirements and high patient satisfaction scores. Patient-related factors (anatomical and stone related) and availability of technical equipment and surgical expertise appear to be the most important determining factors in treatment planning.


Ultra-mini PCNL Percutaneous nephrolithotomy Ureteroscopy URS RIRS Urolithiasis Pain Analgesic consumption Patient satisfaction 



Cumulative Analgesic Consumption Score


Clinical-reported outcome


Evidence-based medicine


Freiburg Index for Patient Satisfaction


Health-related quality of life


Patient-reported outcome


Retrograde intrarenal surgery


Flexible ureterorenoscopy


Ultra-mini PCNL



The study received own institutional funding (University Medical Center Freiburg), and no external or industrial funding was received.

Conflict of interest

Martin Schoenthaler is a consultant in contract with Schoelly GmbH, Denzlingen, Germany, and NeoTract Inc., Pleasanton, USA (not related to the manuscript). Arkadiusz Miernik is a consultant in contract with Schoelly GmbH, Denzlingen, Germany (not related to the manuscript). The other authors declare no conflicts of interest.

Ethical standard

The study has been approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants gave their informed consent prior to their inclusion in the study. Number 504/14, Ethic committee University Medical Center Freiburg.


  1. 1.
    Tuerk C, Knoll T, Petrik A et al (2014) EAU guidelines on urolithiasis [Internet].
  2. 2.
    de la Rosette J, Assimos D, Desai M et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17CrossRefPubMedGoogle Scholar
  3. 3.
    Desai J, Solanki R (2013) Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int 112:1046–1049. doi: 10.1111/bju.12193 PubMedGoogle Scholar
  4. 4.
    Sabnis RB, Ganesamoni R, Doshi A et al (2013) Micropercutaneous nephrolithotomy (microperc) versus retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 112:355–361. doi: 10.1111/bju.12164 CrossRefPubMedGoogle Scholar
  5. 5.
    Schoenthaler M, Wilhelm K, Hein S et al (2015) Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm. World J Urol. doi: 10.1007/s00345-015-1489-4 Google Scholar
  6. 6.
    Garcia SF, Cella D, Clauser SB et al (2007) Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol 25:5106–5112. doi: 10.1200/JCO.2007.12.2341 CrossRefPubMedGoogle Scholar
  7. 7.
    Srikandarajah S, Gilron I (2011) Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. Pain 152:1734–1739. doi: 10.1016/j.pain.2011.02.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Schoenthaler M, Miernik A, Offner K et al (2014) The cumulative analgesic consumption score (CACS): evaluation of a new score to describe postsurgical analgesic consumption as a surrogate parameter for postoperative pain and invasiveness of surgical procedures. Int Braz J Urol 40:330–336CrossRefPubMedGoogle Scholar
  9. 9.
    Miernik A, Farin E, Kuehhas FE et al (2013) Freiburger Index für Patientenzufriedenheit: interdisziplinäre Validierung eines psychometrischen Instrumentes zur Erfassung behandlungsbezogener Patientenzufriedenheit. Chir 84:511–518. doi: 10.1007/s00104-012-2441-4 CrossRefGoogle Scholar
  10. 10.
    Opondo D, Gravas S, Joyce A et al (2014) Standardization of patient outcomes reporting in percutaneous nephrolithotomy. J Endourol 28:767–774. doi: 10.1089/end.2014.0057 CrossRefPubMedGoogle Scholar
  11. 11.
    De la Rosette JJMCH, Opondo D, Daels FPJ et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62:246–255. doi: 10.1016/j.eururo.2012.03.055 CrossRefPubMedGoogle Scholar
  12. 12.
    Schoenthaler M, Wilhelm K, Kuehhas FE et al (2012) Postureteroscopic lesion scale: a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol 26:1425–1430. doi: 10.1089/end.2012.0227 CrossRefPubMedGoogle Scholar
  13. 13.
    Vassilakopoulos T, Mastora Z, Katsaounou P et al (2000) Contribution of pain to inspiratory muscle dysfunction after upper abdominal surgery: a randomized controlled trial. Am J Respir Crit Care Med 161:1372–1375. doi: 10.1164/ajrccm.161.4.9907082 CrossRefPubMedGoogle Scholar
  14. 14.
    Miernik A, Wilhelm K, Ardelt PU et al (2012) Standardized flexible ureteroscopic technique to improve stone-free rates. Urology 80:1198–1202. doi: 10.1016/j.urology.2012.08.042 CrossRefPubMedGoogle Scholar
  15. 15.
    Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584. doi: 10.1016/j.juro.2012.08.197 CrossRefPubMedGoogle Scholar
  16. 16.
    Vicentini FC, Marchini GS, Mazzucchi E et al (2014) Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 83:1248–1253. doi: 10.1016/j.urology.2013.12.041 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Surgery, Clinic for UrologyUniversity Medical Centre FreiburgFreiburgGermany

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