Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study

Abstract

Objective: The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasis is being used as an alternative modality to the conventional PCNL. However its use in the supine position has been scarcely reported. Material and methods:Patients who underwent ultra-mini PCNL in the supine position within the time frame of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients were positioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed. Results:The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m 2 . Intrarenal stone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. Conclusion:Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume disease. Studies with a larger cohort may be required to finally validate this technique.

Outcomes of retrograde intrarenal surgery compared with ultra-mini percutaneous nephrolithotomy in the management of renal calculi

“…A systematic review of PCNL with a tract size less than 15Fr showed an overall stone-free rate of 88.3% and no complications above Clavien grade III [7]. Previous umPCNL studies have shown average operative times ranging from 40 to 59 minutes [5, 6, 13], which is comparable to our average of 54 minutes.…”

“…Gupta et al showed stone free rates of 93% in their study of tubeless umPCNL in 15 patients [6]. Agrawal et al had stone free rates of more than 99% in his study of 120 umPCNL (13).…”

Retrograde vs. antegrade flexible nephroscopy for detection of residual fragments following PNL: a prospective study with computerized tomography control

“…Percutaneous nephrolithotomy (PNL) is recommended as the gold standard treatment for management of stones > 20 mm in diameter by both EAU and AUA guidelines (1, 2). Also, with miniaturized instruments, stones < 20 mm can also be treated with high success and low complication rates (3). The main aim of stone surgery is to establish the stone free status due to the fact that residual fragments may result in stone related events.…”