Minimal-Invasive PCNL (Mini-PCNL)

  • Sven LahmeEmail author


Forty years ago conventional PCNL was introduced as a very effective stone treatment modality, which shows excellent stonefree rates. But conventional PCNL is associated with significant complications, such as a high transfusion rate of 10%. In order to minimize the complication rate of a conventional PCNL but to preserve the excellent stonefree, rate the minimally invasive percutaneous nephrolithotomy (Mini-PCNL) in adults was established in 2001. Mini-PCNL is done by means of a miniaturized nephroscope up to 12 F and a small caliber Amplatz sheath (up to 18 F). Although the underlying principle of the Mini-PCNL is similar to the conventional PCNL, there are some significant differences. Stone removal in Mini-PCNL is achieved without any forceps or baskets. Due to the particular relation of the length and diameter of the Amplatz sheath in Mini-PCNL, the so-called vacuum-cleaner takes all stone fragments automatically out of the calyceal system. Mini-PCNL can be applied in almost all stone patients with stones of the upper urinary tract exceeding 2 cm. Even staghorn stones can be successfully treated by a multi-tract Mini-PCNL approach. Recently various modifications of Mini-PCNL were presented, such as Micro-PCNL, Ultra-Mini-PCNL, Perfect Perc and Super-Mini-PCNL. It can be said today that Mini-PCNL is an indispensable treatment modality in endourological stone treatment.


Percutaneous nephrolithotomy Urolithiasis Holmium laser Minimal-invasive surgery 


  1. 1.
    Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol. 1998;16(6):371–4.CrossRefGoogle Scholar
  2. 2.
    Lahme S, Bichler KH, Strohmaier WL, Götz T. Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol. 2001;40(6):619–24.CrossRefGoogle Scholar
  3. 3.
    Li X, He Z, Wu K, Li SK, Zeng G, Yuan J, He Y, Lei M. Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience. J Endourol. 2009;23(10):1693–7.CrossRefGoogle Scholar
  4. 4.
    Nagele U, Schilling D, Anastasiadis AG, Walcher U, Sievert KD, Merseburger AS, Kuczyk M, Stenzl A. Minimally invasive percutaneous nephrolitholapaxy (MIP). Urologe A. 2008;47(9):1068–73.CrossRefGoogle Scholar
  5. 5.
    Zhu W, Liu Y, Liu L, Lei M, Yuan J, Wan SP, Zeng G. Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis. 2015;43(6):563–70.CrossRefGoogle Scholar
  6. 6.
    Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int. 2013;112(7):1046–9.Google Scholar
  7. 7.
    Zeng G, Wan S, Zhao Z, Zhu J, Tuerxun A, Song C, Zhong L, Liu M, Xu K, Li H, Jiang Z, Khadgi S, Pal SK, Liu J, Zhang G, Liu Y, Wu W, Chen W, Sarica K. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation. BJU Int. 2016;117(4):655–61.CrossRefGoogle Scholar
  8. 8.
    Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69(3):475–82.CrossRefGoogle Scholar
  9. 9.
    Zanetti SP, Talso M, Palmisano F, Longo F, Gallioli A, Fontana M, De Lorenzis E, Sampogna G, Boeri L, Albo G, Trinchieri A, Montanari E. Comparison among the available stone treatment techniques from the first European Association of Urology Section of Urolithiasis (EULIS) survey: do we have a Queen? PLoS One. 2018;13:e0205159.CrossRefGoogle Scholar
  10. 10.
    Lahme S. Miniaturisation of PCNL. Urolithiasis. 2018;46(1):99–106.CrossRefGoogle Scholar
  11. 11.
    Gao XS, Liao BH, Chen YT, Feng SJ, Gao R, Luo DY, Liu JM, Wang KJ. Different tract sizes of miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. J Endourol. 2017;31(11):1101–10.CrossRefGoogle Scholar
  12. 12.
    Hyams ES, Munver R, Bird VG, Uberoi J, Shah O. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol. 2010;24(10):1583–8.CrossRefGoogle Scholar
  13. 13.
    Lahme S, Zimmermanns V, Hochmuth A, Janitzki V. Minimally invasive PCNL (mini-perc). Alternative treatment modality or replacement of conventional PCNL? Urologe A. 2008;47(5):563–8.CrossRefGoogle Scholar
  14. 14.
    Schilling D, Winter B, Merseburger AS, Anastasiadis AG, Walcher U, Stenzl A, Nagele U. Use of a gelatine-thrombin matrix for closure of the access tract without a nephrostomy tube in minimally invasive percutaneous nephrolitholapaxy. Urologe A. 2008;47(5):601–7.CrossRefGoogle Scholar
  15. 15.
    Zhong W, Zeng G, Wu W, Chen W, Wu K. Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res. 2011;39(2):117–22.CrossRefGoogle Scholar
  16. 16.
    Abdelhafez MF, Bedke J, Amend B, Elganainy E, Aboulella H, Elakkad M, Nagele U, Stenzl A, Schilling D. Minimally invasive percutaneous nephrolitholapaxy (PCNL) as an effective and safe procedure for large renal stones. BJU Int. 2012;110(11 Pt C):E1022–6.CrossRefGoogle Scholar
  17. 17.
    Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of minimally invasive (micro and ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review. Curr Urol Rep. 2018;19(4):27.CrossRefGoogle Scholar
  18. 18.
    Yan X, Al-Hayek S, Gan W, Zhu W, Li X, Guo H. Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder). Pediatr Surg Int. 2012;28(10):1021–4.CrossRefGoogle Scholar
  19. 19.
    Bader MJ, Grützke C, Seitz M, Sharma R, Stief CG, Desai M. The “all-seeing-needle“: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol. 2011;59(6):1054–9.CrossRefGoogle Scholar
  20. 20.
    Desai JD. Prospective outcomes of 11-13Ch. Ultra-mini percutaneous nephrolithotomy (UMP): a consecutive cohort study. Arch Esp Urol. 2017;70(1):202–10.PubMedGoogle Scholar
  21. 21.
    Hennessey DB, Kinnear NK, Troy A, Angus D, Bolton DM, Webb DR. Mini PCNL for renal calculi: does size matter? BJU Int. 2017;119(Suppl 5):39–46.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of UrologyGoldstadt Private ClinicPforzheimGermany

Personalised recommendations