Standard v mini percutaneous nephrolithotomy in the supine modified lithotomy position: a randomized pilot study on 10-25 mm stones.
complications
lithotripsy
percutaneous nephrolithotomy
renal stone
ureterorenoscopy
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
revised:
24
03
2024
received:
13
11
2023
accepted:
22
08
2024
medline:
1
10
2024
pubmed:
1
10
2024
entrez:
1
10
2024
Statut:
aheadofprint
Résumé
Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter. Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications. Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4-10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study. There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost-effective alternative to laser pyeloscopic stone procedures.
Sections du résumé
BACKGROUND
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.
METHODS
METHODS
Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications.
RESULTS
RESULTS
Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4-10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study.
CONCLUSION
CONCLUSIONS
There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost-effective alternative to laser pyeloscopic stone procedures.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Türk C, Petřík A, Sarica K et al. EAU guidelines on interventional treatment for urolithiasis. Eur. Urol. 2016; 69: 475–482.
Yuri P, Hariwibowo R, Soeroharjo I et al. Meta‐analysis of optimal management of lower pole stone of 10–20 mm: flexible ureteroscopy (FURS) versus extracorporeal shock wave lithotripsy (ESWL) versus Percutaneus nephrolithotomy (PCNL). Acta Med. Indones. 2018; 50: 18–25.
McCahy P, Hong M, Paul E et al. Shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy for 1–2 cm renal stones: a randomised pilot study. J. Clin. Urol. 2020; 13: 413–418.
Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “mini‐perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J. Urol. 1998; 16: 371–374.
McCahy P, Rzetelski‐West K, Gleeson J. Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous nephrolithotomy. J. Endourol. 2013; 27: 705–709.
Humphreys MR, Shah OD, Monga M et al. Dusting versus basketing during ureteroscopy‐which technique is more efficacious? A prospective multicenter trial from the EDGE research consortium. J. Urol. 2018; 199: 1272–1276.
Qin P, Zhang D, Huang T, Fang L, Cheng Y. Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2 cm: a systematic review and meta‐analysis. Int. Braz J Urol 2022; 48: 637–648.
Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y. Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J. Endourol. 2010; 24: 1579–1582.
Zhu W, Liu Y, Liu L et al. Minimally invasive versus standard percutaneous nephrolithotomy: a meta‐analysis. Urolithiasis 2015; 43: 563–570.