Minimally invasive percutaneous nephrolitholapaxy (PCNL) as an effective and safe procedure for large renal stones

Abdelhafez, Mohamed F.; Bedke, Jens; Amend, Bastian; ElGanainy, Ehab O.; Aboul-Ella, Hassan A.; El-Akkad, M. M.; Nagele, Udo; Stenzl, Arnulf; Schilling, David

doi:10.1111/j.1464-410x.2012.11191.x

Cited by 52 publications

(38 citation statements)

References 18 publications

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“…With the advent of newer technology in optics and lasers, plenty of options in the form of mini PCNL (MIP),[4] UMP[5] and micro PCNL[6] have come up. These have achieved good success rates with lower complication rates as compared to conventional PCNL owing to the size of the tract.…”

Section: Discussionmentioning

confidence: 99%

“…The tract size has decreased considerably in the newer minimally-invasive modalities of PCNL such as mini-PCNL,[4] ultra-mini PCNL (UMP),[5] and micro-PCNL,[6] but concerns remain about small fragments produced with laser lithotripsy migrating to other parts of the pelvi-calyceal system. Keeping this in mind, we have devised a new technique of PCNL termed “Superperc” utilizing suction to remove all the fragments and maintaining low intrapelvic pressure and keeping one-way flow.…”

Section: Introductionmentioning

confidence: 99%

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Superperc: A new technique in minimally-invasive percutaneous nephrolithotomy

Shah

Agrawal²,

Mishra³

2017

Indian J Urol

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Introduction:Percutaneous nephrolithotomy (PCNL) has undergone significant changes in recent years in the quest for improving efficacy and reducing morbidity. Newer minimally-invasive modalities of PCNL such as mini-PCNL, ultra-mini PCNL, and micro-PCNL have evolved with advancement in optics and technology. However, with these newer advancements, migration of small fragments produced with laser lithotripsy remains a concern, which may result in incomplete stone clearance. We describe a new technique of PCNL termed “Superperc”, that utilizes suction to remove all the fragments and maintain one-way flow.Methods:This was a prospective observational study involving 52 consecutive patients who underwent PCNL with the Superperc technique from April 2014 to June 2015. Surgery was performed using a pediatric ureteroscope used as a nephroscope and a specially designed sheath with a suction attachment. The Superperc uses a 10/12 F tract size, specially designed Superperc sheath (Shah Sheath) with suction mechanism and a pediatric ureteroscope (4.5/6 Fr, Richard Wolf) as nephroscope.Results:The mean age of the group was 41.8 years (range 6–84) with 33 males and 19 females. Mean stone size was 19.11 mm (range 10–37 mm) and mean operative time was 40.9 min (range 26–92 min). Twenty-seven renal units had upper calyceal puncture, whereas 12 had middle, 8 lower calyceal and 5 had two punctures. DJ stent was placed in 20 patients, whereas 32 patients were totally tubeless. Only three patients required a nephrostomy tube. The mean hemoglobin drop was 0.32 g with no blood transfusion. Postoperatively, three patients had a mild fever and one had transient hematuria. The stone clearance rate in our study was 96.15% and the mean hospital stay was 31.5 h (range 22–76 h).Conclusion:Superperc is a new technique of minimally-invasive PCNL and can be successfully done with minimal modification in armamentarium, with the potential advantage of good stone clearance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Superperc: A new technique in minimally-invasive percutaneous nephrolithotomy

Shah

Agrawal²,

Mishra³

2017

Indian J Urol

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“…It has been proven to be safe and effective for patients with large or complex renal stones [9][10][11]. The goal of this study is to compare the clinical outcomes between FG and USG MPCNL in the management of large or complex upper urinary tract stones in ADPKD patients.…”

Section: Introductionmentioning

confidence: 99%

“…scores [5][6][7][8][9][10][11] in patients with autosomal dominant polycystic kidney disease (ADPKD). 45 ADPKD patients who were suffering from large or complex upper urinary tract stones (S.T.O.N.E.…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopy versus ultrasonography guided mini-percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease

et al. 2016

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The objective of the study was to compare the therapeutic outcomes between the ultrasonography-guided (USG) and the fluoroscopy-guided (FG) mini-percutaneous nephrolithotomy (MPCNL) for the treatment of large or complex upper urinary tract stones (S.T.O.N.E. scores 5-11) in patients with autosomal dominant polycystic kidney disease (ADPKD). 45 ADPKD patients who were suffering from large or complex upper urinary tract stones (S.T.O.N.E. scores 5-11, mean score 7.6) in 45 renal units were accrued into this retrospective study. They were treated by either USG (20 patients) or FG (25 patients) MPCNL in our center. The treatment results as well as the complications according to the modified Clavien system were assessed and compared. The FG MPCNL group had a higher success rate in accessing the targeted calyces than the USG MPCNL group (96 vs. 70 %, p = 0.048). There was no significant difference observed between the two groups with respect to the operative time, the mean hemoglobin drop, and the stone free rate. The overall operative complications and the perioperative blood transfusion rates were significantly higher in the USG than the FG MPCNL groups, 71.4 vs. 29.2 %, p = 0.011, and 35.7 vs. 4.2 %, p = 0.018, respectively. There was no significant difference between these two groups in terms of major complications (Clavien score 3a-4a) (p = 0.542). In our center, the FG MPCNL was a superior modality to the USG MPCNL in the treatment of large or complex kidney stones in the ADPKD patients. It resulted in higher successful calyceal punctures and less operative complications.

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“…PCNL can also be done safely in both children and elderly except for special circumstances like morbidly obese cases, solitary kidney, renal failure patients 3,4 . Minimally invasive percutaneous nephrolithotomy (MIPCNL) has shown high effi cacy and safety comparable to conventional PCNL in many studies even for the treatment of stone 20 mm including staghorn stone 5 . There has been many modifi cations to this technique.…”

mentioning

confidence: 99%

Double J stenting compared with ureteral catheterization in percutaneous Nephrolithotomy

Joshi

Dongol

Singh

2014

J. Kathmandu Med. Coll.

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Background: Nephrolithiasis represents a large portion in the fi eld of Urological pathology. Minimal invasive and non-invasive therapies have become more accessible and effi cient in the treatment of nephrolithiasis. Percutaneous nephrolithotomy (PCNL) is an effective minimal invasive modality of treating kidney stones. Objectives: To evaluate the outcome of standard percutaneous nephrolithotomy (PCNL) using two different stenting techniques i.e. externalized ureteral catheter placement compared with Double-J stent placement. Methods: This is a prospective study conducted from January 2012 to June 2013 at Kathmandu Medical College Teaching Hospital among patients undergoing percutaneous nephrolithotomy (PCNL). Fifty patients who underwent PCNL were divided into two equal groups: Group 1 (PCNL with Double-J stent placement) and Group 2 (PCNL with externalized ureteral catheter placement). Factors evaluated included stent-related symptoms, postoperative morbidity, and the cost. Morbidity was classifi ed according to the Modifi ed Clavien classifi cation. SPSS 20 was used for statistical evaluation. P value less than 0.05 was considered signifi cant. Results: Stent related morbidity were fever, dysuria, hematuria, burning micturition. Total of 16 stent related complications were seen in group 1 with four of the patients needing early surgical intervention to remove the Double J stent and injectable antibiotics for urinary tract complication due to indwelling stent. In Group 2, seven patients experienced postoperative complications, out of which six were managed conservatively and one patient had grade III A dysuria and hematuria, who underwent immediate stent removal and received injectable antibiotics. There was no reported sepsis and mortality in both groups. Stent was removed in 3-4 weeks' time in group 1 and 3-4 days in group 2. In Group 1, patients had to come one day prior for stent removal. Cost for DJ stent was signifi cantly higher in group I than group II. Conclusion: Standard PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Less cost can be a huge relief to the patients in the third world developing country.

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Minimally invasive percutaneous nephrolitholapaxy (PCNL) as an effective and safe procedure for large renal stones

Cited by 52 publications

References 18 publications

Superperc: A new technique in minimally-invasive percutaneous nephrolithotomy

Superperc: A new technique in minimally-invasive percutaneous nephrolithotomy

Fluoroscopy versus ultrasonography guided mini-percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease

Double J stenting compared with ureteral catheterization in percutaneous Nephrolithotomy

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