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Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study

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Abstract

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann–Whitney, Chi square or Fisher’s exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.

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Abbreviations

PUT:

Plain abdominal radiography

Mini-PNL:

Mini-percutaneous nephrolithotomy

NCCT:

Non-contrast computed tomography scan

PCN:

Percutaneous nephrostomy

PNL:

Percutaneous nephrolithotomy

SFR:

Stone free rate

Standard-PNL:

Standard percutaneous nephrolithotomy

SWL:

Extracorporeal shockwave lithotripsy

US:

Abdominal ultrasonography

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Authors and Affiliations

  1. Urology department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt

    Mohammed S. ElSheemy & Mohammed Hytham

  2. Urology Department, Bani Swaif University, Bani Swaif, Egypt

    Akram A. Elmarakbi

  3. Urology Department, Fayoum University, Fayoum, Egypt

    Hamdy Ibrahim

  4. Vayodah and Venus International Hospitals, Kathmandu, Nepal

    Sanjay Khadgi

  5. Urology Department, Kuwait University, Kuwait City, Kuwait

    Ahmed M. Al-Kandari

Authors
  1. Mohammed S. ElSheemy
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  2. Akram A. Elmarakbi
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  3. Mohammed Hytham
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  4. Hamdy Ibrahim
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  5. Sanjay Khadgi
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  6. Ahmed M. Al-Kandari
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Contributions

ElSheemy: Protocol/project development, data collection and management, data analysis, manuscript writing/editing. Elmarakbi: Protocol/project development, data collection and management. Hytham: Protocol/project development, data collection. Hamdy Ibrahim: Protocol/project development, data collection. Khadgi: Protocol/project development, data collection and management. Al-Kandari: Protocol/project development, data collection and management.

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Correspondence to Mohammed S. ElSheemy.

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The authors declare that they have no conflict of interest. No funding source or industrial links and affiliations.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee.

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Informed consent was obtained from all the individual participants included in the study.

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ElSheemy, M.S., Elmarakbi, A.A., Hytham, M. et al. Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis 47, 207–214 (2019). https://doi.org/10.1007/s00240-018-1055-9

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