The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study

Abstract

To compare the success and complications of ultra-mini percutaneous nephrolithotomy (UPNL) and standard percutaneous nephrolithotomy (SPNL) techniques. We prospectively analyzed 50 patients who underwent SPNL, and 47 patients who underwent UPNL. The patients with a stone size equal to or smaller than 25 mm and we used flipping a coin as the randomization technique. The mean stone size was 20.9 ± 3.6 mm in SPNL, and 20.3 ± 3.0 mm in ultra-mini PNL groups. Stone free rates were 88 % (44/50 patients) and 89.3 % (42/47 patients) in SPNL and UPNL groups, respectively, without any significant difference in between (p = 0.33). No major complications were seen in the UPNL group. PNL has been modified into micro PNL and UPNL parallel to the technological advances to decrease the complications of PNL. When performed as we do UPNL may be an alternative method to SPNL without any additional smaller-calibred nephroscope and with a similar high success rate.

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References

  1. 1.

    Turk C (2015) EAU guidelines on urolithiasis. http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urolithiasis-2015-v2.pdf. Accessed 10 Feb 2016

  2. 2.

    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

    Article  PubMed  Google Scholar 

  3. 3.

    Cicekbilek I, Resorlu B, Oguz U, Kara C, Unsal A (2015) Effect of percutaneous nephrolithotomy on renal functions in children: assessment by quantitative SPECT of (99m)Tc-DMSA uptake by the kidneys. Ren Fail 37:1118–1121

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Desai J, Solanki R (2013) Ultra-mini PCNL. European urology supplements. In: 28th annual EAU congress, 15–19 March, Milan, Italy

  5. 5.

    Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M (2011) Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 186:140–145

    Article  PubMed  Google Scholar 

  6. 6.

    Tepeler A, Sarica K (2013) Standard, mini, ultra-mini, and micro percutaneous nephrolithotomy: what is next? A novel labeling system for percutaneous nephrolithotomy according to the size of the access sheath used during procedure. Urolithiasis 41:367–368

    Article  PubMed  Google Scholar 

  7. 7.

    Kukreja R, Desai M, Patel S, Bapat S (2004) Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 18:715–722

    Article  PubMed  Google Scholar 

  8. 8.

    Helal M, Black T, Lockhart J, Figueroa TE (1997) The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithotomy. J Endourol 11:171–172

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Dore B (2006) Complications of percutaneous nephrolithotomy: risk factors and management. Ann Urol (Paris) 40:149–160

    CAS  Article  Google Scholar 

  10. 10.

    De S, Autorino R, Kim FJ (2015) Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 67:125–137

    Article  PubMed  Google Scholar 

  11. 11.

    Landman J, Lee DI, Lee C, Monga M (2003) Evaluation of overall costs of concurrently available small flexible ureteroscopes. Urology 62:218–222

    Article  PubMed  Google Scholar 

  12. 12.

    Karatag T, Tepeler A, Silay MS, Bodakci MN, Buldu I, Daggulli MA (2015) Comparison of 2 percutaneous nephrolithotomy techniques for the treatment of pediatric kidney stones of sizes 10–20 mm: microperc vs miniperc. Urology 85:1015–1018

    Article  PubMed  Google Scholar 

  13. 13.

    Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906

    Article  PubMed  Google Scholar 

  14. 14.

    Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S (2013) Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31:1581–1586

    Article  PubMed  Google Scholar 

  15. 15.

    Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190

    Article  PubMed  Google Scholar 

  16. 16.

    Choi SW, Kim KS, Kim JH, Park YH, Bae WJ, Hong SH (2014) Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost. J Endourol 28:1487–1494

    Article  PubMed  Google Scholar 

  17. 17.

    Rifaioglu MM, Onem K, Buldu I, Karatag T, Istanbulluoglu MO (2014) Tubeless percutaneous nephrolithotomy: yes but when? A multicentre retrospective cohort study. Urolithiasis 42:255–262

    Article  PubMed  Google Scholar 

  18. 18.

    Bilen CY, Gunay M, Ozden E, Inci K, Sarikaya S, Tekgul S (2010) Tubeless mini percutaneous nephrolithotomy in infants and preschool children: a preliminary report. J Urol 184:2498–2502

    Article  PubMed  Google Scholar 

  19. 19.

    Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW (1998) The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 16:371–374

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Lahme S, Bichler KH, Strohmaier WL, Götz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40:619–624

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Tepeler A, Armagan A, Sancaktutar AA, Silay MS, Penbegul N, Akman T et al (2013) The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol 27:13–18

    Article  PubMed  Google Scholar 

  22. 22.

    Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M (2012) ‘Microperc’ micro percutaneous nephrolithotomy: evidence to practice. Curr Opin Urol 22:134–138

    Article  PubMed  Google Scholar 

  23. 23.

    Tepeler A, Akman T, Silay MS, Akcay M, Ersoz C, Kalkan S et al (2014) Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy. Urolithiasis. 42:275–279

    Article  PubMed  Google Scholar 

  24. 24.

    Karatag T, Buldu I, Inan R, Istanbulluoglu MO (2015) Is micropercutaneous nephrolithotomy technique really efficacicous for the treatment of moderate size renal calculi? Yes. Urol Int 95:9–14

    Article  PubMed  Google Scholar 

  25. 25.

    Kukreja RA, Desai MR, Sabnis RB, Patel SH (2002) Fluid absorption during percutaneous nephrolithotomy: does it matter? J Endourol 16:221–224

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Stenberg A, Bohman SO, Morsing P, Müller-Suur C, Olsen L, Persson AE (1998) Back-leak of pelvic urine to the bloodstream. Acta Physiol Scand 134:223–234

    Article  Google Scholar 

  27. 27.

    Shah AK, Xu K, Liu H, Huang H, Lin T, Bi L et al (2015) Implementation of ultramini percutaneous nephrolithotomy for treatment of 2–3 cm kidney stones: a preliminary report. J Endourol 29:1231–1236

    Article  PubMed  Google Scholar 

  28. 28.

    Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z et al (2016) Percutaneous nephrolithotomy: update, trends, and future directions. Eur Urol. doi:10.1016/j.eururo.2016.01.047. (Epub ahead of print)

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Correspondence to Muhammet Fatih Kilinc.

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Informed consent was obtained from all of the participants that were included in the study.

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Karakan, T., Kilinc, M.F., Doluoglu, O.G. et al. The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study. Urolithiasis 45, 209–213 (2017). https://doi.org/10.1007/s00240-016-0890-9

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Keywords

  • Percutaneous lithotripsy
  • Operative complication
  • Urolithiasis