The use of ureteral access sheath during mini-percutaneous nephrolithotomy with high-power holmium YAG laser.
World J Urol 2022;
40:789-794. [PMID:
34853917 DOI:
10.1007/s00345-021-03894-0]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE
To present our preliminary results and describe a technical modification of mini-PCNL (12Fr) with the insertion of a ureteral access sheath (UAS) to facilitate the procedure.
METHODS
A prospective study for the time period of January 2020 to January 2021 was conducted including patients with renal stones sized ≤ 25 mm in whom prone mini-PCNL (tract size 12Fr) together with the retrograde insertion of UAS was performed. All patients had been prestented at least 1 week prior to the planned surgery. A single-step tract dilation to 12Fr diameter was performed through a nonpapillary medial puncture. The lithotripsy was achieved using high-power holmium yttrium aluminum garnet laser (Ho:YAG) with the 60 W power setting (40 Hz and 1.5 J). The follow-up investigations were planned at 1-month after the surgery.
RESULTS
In total, 32 patients with the median age and stone size of 56.5 (IQR = 53-62) years and 20.8 (IQR = 19.3-22.7) mm were included. The median operative and cumulative fluoroscopy time were 34.0 (IQR = 29.9-37.5) and 1.9 (1.8-2.1) min, respectively. The stone-free rate (SFR) at 1-month follow-up was 93.8% (30/32). Only one patient developed a fever and required prolonged antibiotic administration. None of the patients experienced clinically significant bleeding.
CONCLUSION
Our preliminary results showed that the use of UASs during mini-PCNL procedures is feasible and provides directed evacuation of the stone fragments reaching 93.8% SFR at a 1-month follow-up. Future well-designed studies are necessary to prove our findings.
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