Extending indications of micropercutaneous nephrolithotomy: It is not just about cracking stones

Abstract

ObjectiveTo describe our experience and results of using the MicroPerc™ micropercutaneous nephrolithotomy armamentarium (PolyDiagnost, Germany) for unusual indications unexplored using this modality.Patients and methodsWe used the MicroPerc™ system for stone clearance in three ureteric calculi, two bladder calculi, one case of urethral calculus, for antegrade biopsy in a case of upper tract urothelial carcinoma, for Deflux® (dextranomer/hyaluronic copolymer, Salix Pharmaceuticals, Uppsala, Sweden) injection in three cases of vesico-ureteric reflux (VUR), and three cases of posterior urethral valve (PUV) fulgurations. A 4.85-F ‘All-Seeing Needle®’ (PolyDiagnost) was used in most of the cases. An 8-F mini-micro sheath was used where stability was deemed necessary. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications, and outcomes were assessed.ResultsAll patients were successfully treated with complete stone clearance at 1 month with no residual fragments. The antegrade biopsy confirmed a high-grade papillary neoplasm. There were no technical difficulties with injection of Deflux or PUV fulgurations. Follow-up at 1 year revealed no stone recurrence, resolved reflux in all three cases, and all the children that had had PUVs were voiding well. The small sample and retrospective nature of the analysis are the limitations of this study.ConclusionMicroPerc™, besides its usual use for minimally invasive percutaneous nephrolithotomy, can also be feasibly used for ureteric, bladder and urethral stones, and for treating non-calculus diseases such as PUVs and VUR. True to its name, it may be an ‘All-Seeing Needle’ in reality with much more to offer and harvest from.

Intra-operative Postperfusion Micronephrolithotomy for Renal Allograft Lithiasis: A Case Report

“…[3] Nevertheless, successful treatment of ureteral, bladder, and urethral calculi has been recently reported. [4] We herein describe for the first time a case of successful intra-operative, post-perfusion allograft micronephrolithotomy.…”

The initial clinical application of standard PCNL combined with visual needle nephroscope in the treatment of complex renal calculi

“…Whereas when the puncture enters the intrarenal collecting system, it can increase the precision of puncture by visually monitoring before dilating the puncture channel, and determine whether the puncture position is ideal, avoids blind dilation [13]. When used as a nephroscope, after visual puncture into the target calyces, through its built-in working channel, 200μm holmium laser can be directly utilized for lithotripsy, which eliminates the need to dilate the puncture channel, thereby greatly reducing surgical trauma and reducing surgical risk [14].…”