Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Abstract

Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retrocatheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

Mini-Perc for Renal Stones—A Single Center Experience and Literature Review

“…Since this technique is not explicitly mentioned by the current guidelines, the authors did a thorough review of the literature and meta-analysis, being able to demonstrate the superiority of this combined approach in terms of stone-free rate, operative time, complications and the number of access tracts, an important limit of percutaneous surgery. The authors conclude that for complex stones, the combined access is superior to PCNL alone [ 31 ].…”

Mini PCNL for renal calculi: does size matter?

“…The MIP nephroscope, due to its small size, passes easily in to the proximal ureter and is particularly well suited for the [38] 191 -Small vs large 84 23 Long et al [8] 163 -Ureteric stones 96 0 (major) Zhan et al [39] 109 -Supine vs prone 89 -Hu et al [40] 1 368 --82 20 Gu et al [41] 611 --82 6 Xu et al [42] 1 200 843 mm 2 UTI vs no UTI -7.6 Zhu et al [43] 450 -II vs USS 80 -Akbulut et al [44] 182 -Obese vs non-obese 71 -Zeng et al [45] 146 22 mm Super-mPCNL 90 13 Zhao et al [46] 145 -1-vs 2-stage mPCNL 83 -Agrawal et al [47] 120 --99 0 (major) Liu et al [48] 105 -Single-vs multi-tract 50 30 II, image intensifier; USS; ultrasound scan. *Stone size listed as either maximum dimension, or volume.…”

Comparison of pre-indwelling double-J stents versus ureteral catheters for artificial hydronephrosis in percutaneous nephrolithotomy: A retrospective cohort study

“…Traditional PCNL surgery generally involves pre-placing a ureteral catheter and injecting normal saline into the renal pelvis or initiating a continuous drip of saline to create artificial hydronephrosis. However, many studies have reported the disadvantages of this approach [ 11 12 ]. For instance, an anterograde position of the indwelling double-J stents at the end of the surgery has shortcomings and increases the operation time, especially when an emergency happens like massive bleeding and the operation cannot be stopped immediately.…”