Fan J et al, 2018: The role of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS).
Fan J, Zhang T, Zhu W, Gurioli A, Ketegwe IR, Zeng G.
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, Guangdong, 510230, China.
Department of Urology, Turin University of Studies, Turin, Italy.
To assess the safety and efficacy of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS), we retrospectively evaluated 44 patients with symptomatic LPSs with previously failed SWL or RIRS and consequently underwent SMP from October 2014 to March 2016. The percutaneous renal access was performed 12-14F with C-arm fluoroscopy or ultrasonographic guidance. Stone disintegration was performed using either Holmium laser or pneumatic lithotripter. Perioperative parameters along with operations were assessed in detail. A total of 44 patients (mean age 49.1 ± 13.7 years) were included in the study. Stone size was 18.4 ± 6.0 mm (range 9-29), operative time was 63.9 ± 32.7 min (range 14-145) and hospital stay was 2.8 ± 1.2 days (range 1-5). The hemoglobin drop was 12.4 ± 8.8 g/L (range 0-31), and no patients required blood transfusion. Complete stone-free status was achieved in 40 (90.9%) patients. Clinically insignificant residual fragments were observed in three (6.8%) patients and only one (2.3%) patient had a 6 mm residual calculus. A total of three minor complications (urinary tract infection, hemorrhage resolved by hemostatics and renal colic requiring analgesics) were observed postoperatively. For symptomatic LPSs after the failure of SWL or RIRS, SMP is a safe and efficient auxiliary option and even might be an alternative to SWL or RIRS, while further considering the stone-free rates and stone-related events.
Urolithiasis. 2018 Jun 15. doi: 10.1007/s00240-018-1068-4. [Epub ahead of print]
This publication comes from a department with extensive experience in super-mini percutaneous nephrolithotomy (SMP). “All the procedures were performed at a single tertiary unit by a single surgeon who had experienced over 5000 cases of
mini-PCNL.” Of the 44 patients 52 had residuals after ESWL and 48 % after RIRS. The fact that 9% had uric acid stones is surprising as the treatment with oral chemolysis is usually uncomplicated and very successful.
The good success rate and a low complication rate lead the authors to propose SMP as a primary procedure in lower pole stones.