Yang Liu1 1 Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; , Chao Cai1 1 Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; , Albert Aquino2 2 Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines; , Shabir Al-Mousawi3 3 Division of Urology, SABAH ALAHMAD Urology Center, Ministry of Health, Al-Amiri Hospital, Kuwait City, Kuwait; , Xuepei Zhang4 4 Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; , Simon K S Choong5 5 Institute of Urology, University College London Hospitals, London, UK , et al.
BJU Int. 2020 Jul;126(1):168-176.
COMMENT
Percutaneous nephrolithotomy (PCNL) is the gold standard surgical treatment for large renal kidney stones (>2.0 cm) according to EUA and AUA guidelines (11. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69:468-74., 22. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196:1161-9.). However, this procedure is related to a higher morbidity (longer hospital stay and higher blood loss) when compared to retrograde intrarenal surgery (RIRS). Improvements and miniaturization of surgical devices with enriched technology aim to reach the optimal stone clearance with the lowest complication rate. Liu et al. in this retrospective multi-center study comparing 2 groups with 1380 matched patients with kidney stones > 2.0 cm showed that super mini-PCNL (8 F nephroscope; 12 or 14 F sheath; 0.8 mm pneumatic lithotripter or 550 μm fiber) has lower perioperative hemoglobin drop, shorter hospital stay, lower postoperative pain score with higher tubeless rate, reaching a similar stone-free rate when compared to mini-PCNL. Moreover, for stones raging from 2 to 3 cm, super mini-PCNL had a higher stone-free rate. In another study, when compared to standard PCNL for treatment of kidney stones up to 2,0 cm, super mini-PCNL achieved equal stone-free rate, whereas had a shorter hospital, and lower incidence of bleeding and postoperative pain (33. Guddeti RS, Hegde P, Chawla A, de la Rosette JJMCH, Laguna Pes MP, Kapadia A. Super-mini percutaneous nephrolithotomy (PCNL) vs standard PCNL for the management of renal calculi of <2 cm: a randomised controlled study. BJU Int. 2020;126:273-9.).
Several authors have already reported favorable outcomes of mini-PCNL when compared to RIRS (44. Gao XS, Liao BH, Chen YT, Feng SJ, Gao R, Luo DY, et al. Different Tract Sizes of Miniaturized Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. J Endourol. 2017 Nov;31(11):1101-1110.
5. Cabrera JD, Manzo BO, Torres JE, Vicentini FC, Sánchez HM, Rojas EA, Lozada E. Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20 mm lower pole renal stones: a systematic review and meta-analysis. World J Urol. 2020;38:2621-8.-66. Pelit ES, Kati B, Çanakci C, Sağir S, Çiftçi H. Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience. Int Braz J Urol. 2017;43:9328.). A similar or a higher stone-free rate is the main advantage. For lower pole kidney stone this advantage of mini-PCNL is even clearer. Certainly, miniaturization and incorporation of new technologies will be the future of endourology and will help urologists to achieve better postoperative outcomes.
References
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1Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69:468-74.
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2Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196:1161-9.
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3Guddeti RS, Hegde P, Chawla A, de la Rosette JJMCH, Laguna Pes MP, Kapadia A. Super-mini percutaneous nephrolithotomy (PCNL) vs standard PCNL for the management of renal calculi of <2 cm: a randomised controlled study. BJU Int. 2020;126:273-9.
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4Gao XS, Liao BH, Chen YT, Feng SJ, Gao R, Luo DY, et al. Different Tract Sizes of Miniaturized Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. J Endourol. 2017 Nov;31(11):1101-1110.
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5Cabrera JD, Manzo BO, Torres JE, Vicentini FC, Sánchez HM, Rojas EA, Lozada E. Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20 mm lower pole renal stones: a systematic review and meta-analysis. World J Urol. 2020;38:2621-8.
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6Pelit ES, Kati B, Çanakci C, Sağir S, Çiftçi H. Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience. Int Braz J Urol. 2017;43:9328.
Publication Dates
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Publication in this collection
30 July 2021 -
Date of issue
Sep-Oct 2021
