Miniaturised percutaneous nephrolithotomy: Its role in the treatment of urolithiasis and our experience

Abstract

Miniaturized percutaneous nephrolithotomy (PCNL) procedures have gained increased popularity in recent years. They aim to reduce percutaneous tract size in order to lower complication rates, while maintaining high stone-free rates. Recently, miniaturized PCNL techniques have further expanded, and can currently be classified into mini-PCNL, minimally invasive PCNL (MIP), Chinese mini-PCNL (MPCNL), ultra-mini-PCNL (UMP), micro-PCNL, mini-micro-PCNL, and super-mini-PCNL (SMP). However, despite its minimally-invasive nature, its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate. The aim of this review is to summarise different available modalities of miniaturized PCNL, details of instruments involved, and their corresponding safety and efficacy. In particular, this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis. Overall, miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients. Well-designed, randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.

Outcome of mini percutaneous nephrolithotomy ‘miniPCNL’ in children

“…The recent review on this topic summarizes available modalities of PCNL instruments and miniaturized PCNL which appears to be safe and effective for both adult and children. 17 Our series shows that miniPCNL is safe in children. Our experience further strengthens the concept of proper access to correct calices whenever possible for complete stone clearance and better outcome with less morbidity.…”

“…The miniaturization of PCNL techniques has progressed in recent years. 17 However, the superiority of minimally-invasive nature is still under debate for safety and efficacy compared to conventional PCNL in children. The recent review on this topic summarizes available modalities of PCNL instruments and miniaturized PCNL which appears to be safe and effective for both adult and children.…”

“…1 The goal of active stone treatment strategies should aim to achieve complete stone clearance in a short operative time, short hospital stay and minimal complications. 2 Renal stone disease in children poses a clinical management dilemma due to the size of the urinary tract and risk of recurrence. 3 The majority of renal stones are due to metabolic disorders or infection with a consequently high lifetime risk of recurrence.…”

Comparison of laparoscopic pyelolithotomy and retrograde intrarenal surgery in the management of large renal pelvic stone

“…In addition, the effect of using a percutaneous approach on renal function has not been fully studied and de ned [7,8]. While miniaturized PCNL techniques can decrease complication rates, this comes with a decrease in stone-free rate [9,10].…”

Medical and surgical management of urolithiasis

“…From positioning to exit strategies and all other components of the procedure between start to finish have undergone modification designed to further minimize the invasiveness of the procedure and associated patient morbidity. Mordechai Duvdevani and his colleagues [9] from Hadassah Hospital in Jerusalem provide an excellent update on the new approaches and Guohua Zeng and his colleagues [10] from Guangzhou, China outline the significant trend towards minimizing the size of tract dilation for percutaneous renal procedures. Both articles represent excellent resources for urologists on the current state in performing percutaneous nephrolithotomy.…”