Safety and efficacy of a single middle calyx access (MCA) in mini-PCNL

The Outcome of the Miniaturized Percutaneous Nephrolithotomy in Lateral Position with Guidance of Non-Rotational C-Arm

Objective

Evaluation of the outcome of the miniaturized percutaneous nephrolithotomy in the treatment of nephrolithiasis with a lateral position based on the principle of a right triangle under the guidance of a C-Arm without contrast fluid.

Materials and Methods

Sixty-nine cases of Mini-PCNL with the assistance of a vacuum-assisted sheath in the lateral position were performed at Central Hospital from March 2021 to August 2022. Percutaneous renal access was under the guidance of a non-rotational C-arm without contrast medium, and we determined the puncture location and depth of the needle based on the principle of right triangles.

Results

The median age was 51.6 ± 12.5 years, and males accounted for 68.1% of the cases. 60.9% of all patients had normal weight. The median stone surface area was 361.1mm2, and 59.4% of all cases were graded as 2 regarding Guy's stone score. The successful renal access rate was 100%. The tunnel access from the middle and lower calyx accounted for 94.2%. The median access duration, fluoroscopy duration, and hospital length of stay were 271.7 seconds, 14.79 seconds, and 6.3 days, respectively. The complete stone clearance rate was 78.3%. Bleeding complications occurred in 2 patients without mortality. Three patients required an additional procedure.

Conclusion

The puncture technique into the renal calyxes based on the principle of the right triangle under the guidance of a non-rotational C-Arm without contrast medium in PCNL is a fast, exact, and safe technique.

Totally X-ray-Free Ultrasound-Guided Mini-Percutaneous Nephrolithotomy in Galdakao-Modified Supine Valdivia Position: A Novel Combined Surgery

We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) <0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm2). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a blood transfusion. Complications included transient hematuria (n = 13, 8.7%), bladder blood clot retention (n = 2, 1.3%), fever (n = 15, 10%) and sepsis (n = 2, 1.3%). Totally X-ray-free ultrasound-guided mini-PCNL in the GMSV position is feasible, safe and effective for patients with upper urinary tract stones, indicating the synergistic and complementary effects of the three novel techniques.

Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study

Background and Objective: Several positions have been described for percutaneous nephrolithotomy (PCNL). The aim of this study was to compare the safety and effectiveness of the traditional prone position PCNL (TP-PCNL) and the prone split-leg position PCNL (PSL-PCNL). Patients and Methods: A retrospective review was made of the data of 212 patients who underwent prone PCNL in PSL or TP between January 2017 and November 2019. The demographic and preoperative clinical data were used for propensity score-matching (PSM). Following the PSM based on a multivariable logistic regression model, the PSL-PCNL and TP-PCNL groups were compared in preoperative, perioperative, and postoperative parameters. All surgical procedures were performed by an experienced endourologist. Results: After PSM, 51 patients from the PSL-PCNL group were matched to 51 TP-PCNL patients. The stone burden was not statistically significant between the two groups (p = 0.388). The mean operation time of the two groups was significantly different (81.5 ± 32.4 minutes vs 93.1 ± 25.9 minutes, respectively, p = 0.026). The hemoglobin decrease in the PSL-PCNL group was greater than that in the TP-PCNL group (-17.7 ± 16.9 g/L vs 13.1 ± 10.9 g/L, p < 0.001). Both groups had similar stone-free rates after 2 weeks (p = 0.49). No significant difference was observed between the groups in the total complication rate (p = 1). Conclusions: The application of PSL in PCNL simplifies the surgical procedure and shortens the operating time. Another important advantage is that it allows retrograde intrarenal surgery and ureteroscopy to be performed simultaneously. We recommend the PSL to be applied in PCNL for renal stone patients.

Comparison of standard- and mini-percutaneous nephrolithotomy for staghorn stones

Objectives: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones.

Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18–20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL.

Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P < 0.001).

Conclusions: The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay.