Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience

Abstract

To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL) as compared to standard PCNL (sPCNL) for management of 2-3-cm renal stones in the flank-free modified supine position. Between September 2010 and December 2013, 150 patients (168 renal units) with 2-3-cm renal stones were prospectively randomized into two treatment groups; Group A (75 patients/87 renal units) treated by mPCNL and Group B (75 patients/81 renal units) treated by sPCNL. In both groups, the patients were placed in the flank-free modified supine position. In mPCNL group, the tract was dilated up to 16.5 F whereas in sPCNL group the tract was dilated up to 30 F. Both groups were compared regarding several perioperative parameters. No significant difference was recorded among both groups regarding fluoroscopy time (4.3 ± 1.3 vs 4.8 ± 2.1 min, p = 0.06), operative time (83.2 ± 17.3 vs 78.6 ± 24.4 min, p = 0.16), hospital stay (4.3 vs 4.5 days, p = 0.76), VAS score (3.2 ± 0.6 vs 3.3 ± 0.8, p = 0.36) and need for analgesia. The mean drop in hemoglobin level and the incidence of bleeding that necessitated blood transfusion were significantly lower in the mPCNL group (0.6 ± 0.1 vs 1.9 ± 1.1 g/dl, p < 0.0001 and 1.2 vs 9.8%, p = 0.03, respectively). Although the stone-free rate was higher in the sPCNL group, but this was statistically insignificant (97.1 vs 95.4%, p = 0.86). Mini-PCNL is effective for managing renal calculi with comparable operative time and stone-free rate to standard PCNL with the merit of higher safety due to lower incidence of bleeding that necessitates blood transfusion.

Current trends and pitfalls in endoscopic treatment of urolithiasis

“…Minimally invasive PCNL, which requires dilation to within 20‐Fr, provides greater safety because of the lower incidence of bleeding that necessitates blood transfusion than standard PCNL. It also has an operative time and SFR that are comparable with those for standard PCNL Yamaguchi et al . reported that the incidences of blood transfusion associated with the use of <18, 24–26, 27–30 and 32–34‐Fr tract sheaths were 1.1%, 4.8%, 5.9% and 12.1%, respectively ( P < 0.0001).…”

“…It also has an operative time and SFR that are comparable with those for standard PCNL. 83 Yamaguchi et al reported that the incidences of blood transfusion associated with the use of <18, 24-26, 27-30 and 32-34-Fr tract sheaths were 1.1%, 4.8%, 5.9% and 12.1%, respectively (P < 0.0001). Therefore, the mini-PCNL, which uses a smaller tract sheath, was introduced to decrease the bleeding risk.…”

Pooled-analysis of efficacy and safety of minimally invasive versus standard percutaneous nephrolithotomy

“…[ 10 , 11 , 16 , 18 ] To determine whether the vacuum effect affected the results, 10 RCTs were divided into 2 sub-groups (vacuum suction group [VSG] [ 12 , 17 , 18 ] and non-vacuum suction group [NVSG]). [ 10 , 11 , 13 , 14 , 15 , 16 , 19 ] To determine whether type and quantity of stones affected the results, we extracted SFR and operative time in 4 studies to conduct our meta-analysis. [ 10 , 11 , 16 , 18 ] Relevant characteristics and baseline of articles are listed in Table 1 , and the process of identifying RCTs is displayed in Figure 1 .…”

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

“…mPCNL is de ned as PCNL performed using Amplantz sheaths with a diameter of 14-20 Fr [3,51]. mPCNL has the advantage of reducing complications that may arise from larger instruments and sheaths [4].…”