Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

Abstract

Objective: The aim of study was to compare the efficiency and safety of standard percutaneous nephrolithotomy (sPNL) and miniaturized percutaneous nephrolithotomy (mPNL) in lower calyx and/or pelvic stones smaller than three centimeters. Material and methods:From October 2010 to August 2015, 108 mPNL and 176 sPNL procedures were performed for renal stones smaller than three cm and located in the lower calyx and/or renal pelvis. All patients were evaluated preoperatively with intravenous pyelography and/or computed tomography. Intraoperative parameters, post-operative results and complications were recorded. Postoperative success was defined as complete stone clearance and/or clinically insignificant residual fragments at 3 rd month.Results: Preoperative characteristics were similar between sPNL and mPNL groups except previous renal stone operation history and gender. The mean operation time was significantly shorter in the sPNL group (p<0.001). The mean hemoglobin drop was significantly less in the mPNL group (p= 0.001), we found a 1.27±1.4 and 0.5±1.3 decrease in mean hemoglobin levels (mg/dL) in the sPNL and mPNL groups, respectively. Transfusion rate was 1.9% in mPNL and 5.6% in sPNL groups, and the difference was statistically significant (p=0.048). Only one patient in the sPNL group needed angiography and embolization. Postoperative JJ stent insertion rate was significantly higher in the mPNL group (p= 0.03). Conclusion:Both sPNL and mPNL are safe and effective surgical procedures for lower calyx and/or pelvis stones smaller than 3 cm. However, use of smaller caliber instruments was associated with a lesser hemoglobin drop and need for transfusion.

Comparison of Miniperc and Standard Percutaneous Nephrolithotomy in the Treatment of Renal Stone: An Open Level Parallel Arm Randomized Control Trial

“…Gupta et al 15 in a retrospective study, found that overall stone free rate was 77.5% of patients in miniperc and was 94.0% of patient in standard PCNL respectively. Sarilar et al 9 observed in their study that the success rate of stone clearance was 92.0% in miniperc group and 92.5% in standard PCNL group respectively. Zhu et al 10 in a metaanalysis showed no difference between the miniperc and standard PCNL (P=0.23).…”

“…A retrospective study by Giusti et al 14 found that the mean stone size was 1.67±0.5 in miniperc and 1.83±0.8 for standard PCNL. Sarilar et al 9 showed that size did not correlate significantly with miniperc and standard PCNL (P=0.730).…”