Minimally Invasive PCNL in Patients with Renal Pelvic and Calyceal Stones

Lahme, Sven; Bichler, K.-H.; Strohmaier, Walter; Götz, Tobias

doi:10.1159/000049847

Cited by 194 publications

(100 citation statements)

References 13 publications

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“…Some researchers developed the MPCNL procedure to decrease the size of the nephrostomy tract. 1 Although they found that there was no statistically significant difference between conventional PCNL and mini-PCNL in the loss of functional tissue and postoperative renal scarring, 8 the use of a smaller access sheath results in reduced intraoperative blood loss. [9][10][11] There have been concerns that MPCNL might not be a suitable procedure for complex calculi because of the limited working channel.…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Zeng

Zhao

Wan

et al. 2013

Journal of Endourology

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AbstractsPurpose: To determine whether minimally invasive PCNL (MPCNL) is as safe and effective in the management of complex renal caliceal stones as it is for simple renal stones. Patients and Methods: We retrospectively reviewed 5761(41.2%) simple caliceal stones (isolated renal pelvis including isolated calix) and 8223 (58.8%) complex caliceal stones (renal pelvis accompanying two calices at least) that were managed by MPCNL between 1992 nd 2011. The safety, efficacy, and outcome were compared and analyzed. Results: Stone burden was larger in complex caliceal stones (1763.0 vs 1018.6 mm 2 , P < 0.05). Patients with simple stones had significantly shorter operative time, less frequency of multiple percutaneous accesses, and less hemoglobin drop. They also had a higher initial stone-free rate (SFR) (77.6% vs 66.4%) after a single session of MPCNL (P < 0.05). The differences diminished in the final SFR (86.7% vs 86.1%) after relook and/or auxiliary procedures (P > 0.05). The complication rate (17.9% vs 19.0%) and blood transfusion rate (grade II) (2.2% vs 3.2%) were similar in both groups (P > 0.05). Both groups had a low rate of high Clavien grade complications. Renal vascular embolizations (grade III), however, were significantly higher in patients with complex caliceal stones (P < 0.05). Conclusions: MPCNL is a safe and effective treatment option for patients with complex caliceal stones except there is a slightly higher frequency rate of embolization. There was a higher initial SFR in simple stones, but this difference diminished with secondary procedures.

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Section: Discussionmentioning

confidence: 99%

“…There have been, however, some concerns that by using the miniaturized access, there could be reduced visibility, increased operative time, and a decreased primary stone-free rate (SFR). 1,2 Furthermore, there was no clear definition as to what constitutes mini-PCNL. Reported series had used nephrostomy tracts ranging from 14F to 20F.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Zeng

Zhao

Wan

et al. 2013

Journal of Endourology

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“…Studies further show that creating a smaller tract (i.e. mini-perc technique) may reduce bleeding [24] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy

et al. 2006

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Objectives: Percutaneous nephrolithotomy (PNL) is sometimes associated with complications, especially in patients with complex stones. Herein, we review our experience with PNL to determine the impact of percutaneous access number and location on success and complication rates. Patients and Methods: During a 2-year period, a total of 275 patients with a mean age of 42.3 ± 14.8 (range: 13–75) years underwent PNL. Stones were classified as simple in 51.6%, and complex (staghorn calculi or renal pelvis stones coexisting with caliceal stones) in 48.4%. Percutaneous access was done under C-armed fluoroscopy and the tract was formed with a high-pressure balloon dilation system. One single percutaneous access was sufficient in 210 (76.4%), while 2 accesses were utilized in 44 (16%), and ≧3 accesses in 21 cases (7.6%). Supracostal access was performed in 23 (8.4%) patients. Results: An overall success rate of 94.9% was achieved. Stone location, but not the access point location, was the major determinant for success, which was 99.3 and 90.2% in patients with simple and complex stones, respectively (p < 0.01). Significant complications included bleeding necessitating blood transfusion in 28 (10.2%), and hydropneumothorax in 2 (0.7%) patients. Bleeding was observed in 39.1 and 7.5% of patients managed with supracostal access, and subcostal access, respectively (p < 0.01). An increased number of access points significantly augmented the risk for bleeding. Bleeding was encountered in 7.6% of patients managed with 1 percutaneous access point, and in 18.5% of cases managed with ≧2 access points (p < 0.05). Hydropneumothorax occurred in patients with supracostal access. Conclusion: Supracostal access as well as multiple punctures may be needed especially in the management of complex stones, and the need for multiple access points and supracostal access significantly increases complication rates.

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“…Mini-PCNL was believed to cause fewer traumas than conventional PCNL, but to be much more time-consuming for large stone burden, and thus always preformed as ancillary treatment following standard PCNL [4,5] or when multiple tracts were needed [6]. On the other hand, combined retrograde intrarenal surgery (RIRS) and PCNL was performed with the aim to reduce tract-related blood loss and morbidity and to achieve a high stone-free rate (SFR) [7,8].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Zhong¹,

Zhao²,

Wang

et al. 2014

Urol Int

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Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

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Minimally Invasive PCNL in Patients with Renal Pelvic and Calyceal Stones

Cited by 194 publications

References 13 publications

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

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