Precision Stone Surgery: Current Status of Miniaturized Percutaneous Nephrolithotomy

Abstract

Purpose of Review

Innovations in lasers and surgical technology have led to a renewed interest in the miniaturization of percutaneous nephrolithotomy (PCNL). We review the different approaches and evidence on the efficacy of mini-PCNL.

Recent Findings

Mini-PCNL encompasses a range of techniques using tract sizes from 4.8 to 22 F to treat renal stones. The most common device uses irrigation to passively extract stones out of the sheath. Super-mini-PCNL incorporates active suction. Ultra- and micro-techniques reduce the tract to smaller diameters. Laser fragmentation is the main lithotripsy modality. Studies demonstrate an association with reduced complications, hospital stay, and increased tubeless rate. Drawbacks include longer operative times while stone-free rates for larger stones may be sub-optimal.

Summary

Mini-PCNL has advantages of less trauma and the avoidance of nephrostomy tubes. Ambulatory surgery is feasible in select patients. Advances in laser lithotripsy and active suction have the potential to improve stone clearance and treat larger stones.

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Fig. 1

Abbreviations

PCNL:

Percutaneous nephrolithotomy

AUA :

American Urological Association

EAU:

European Association of Urology

Mini-PCNL:

Miniaturized PCNL

SMP:

Super mini-PCNL

UMP:

Ultra mini-PCNL

μ-PCNL:

Micro-PCNL

US:

Ultrasound

NT :

Nephrostomy tube

SFR:

Stone-free rate

LOS:

Length of stay

URS:

Ureteroscopy

KUB:

Kidney, ureter, and bladder X-ray

RCT:

Randomized controlled trial

RF:

Residual fragment

CT:

Computed tomography

LP:

Lower pole

HU:

Hounsfield unit

ECIRS:

Endoscopic combined intrarenal surgery

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Correspondence to John M. DiBianco.

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Dr. Ghani reports personal fees from Lumenis, grants and personal fees from Boston Scientific, personal fees from Olympus, personal fees from Coloplast, grants from Blue Cross Blue Shield of Michigan, outside the submitted work.

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DiBianco, J.M., Ghani, K.R. Precision Stone Surgery: Current Status of Miniaturized Percutaneous Nephrolithotomy. Curr Urol Rep 22, 24 (2021). https://doi.org/10.1007/s11934-021-01042-0

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Keywords

  • Nephrolithiasis
  • PCNL
  • Mini-PCNL
  • Technology