Guohua Zeng1, ShawPong Wan2, Zhijian Zhao1, Jianguo Zhu3, Aierken Tuerxun4, Chao Song5, Liang Zhong6, Ming Liu7, Kewei Xu8, Hulin Li9, Zhiqiang Jiang10, Sanjay Khadgi11, Shashi K Pal12, Jianjun Liu13, Guoxi Zhang14, Yongda Liu1, Wenqi Wu1, Wenzhong Chen1, Kemal Sarica15. 1. Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 2. Chinese-American Urology Stone Center, First People's Hospital of Xiaoshan, Hangzhou, China. 3. Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China. 4. Department of Urology, the First People's Hospital of Kashi, Kashi, Xinjiang, China. 5. Department of Urology, Hubei Provincial People's Hospital, Wuhan, China. 6. Department of Urology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China. 7. Department of Urology, Changsha Centre Hospital, Changsha, China. 8. Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China. 9. Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China. 10. Department of Urology, The third Xiangya Hospital of Xiangya Medical College, Central South University, Changsha, China. 11. Department of Urology, Venus International Hospital (SK), Kathmandu, Nepal. 12. Department of Urology, Lions Kidney Hospital and Urology Research Institute, New Delhi, India. 13. Department of Urology, the First Affiliated Hospital of Guangdong Medical College, Zhanjiang, China. 14. Department of Urology, the First Affiliated Hospital of Gannan Medical University, Ganzhou, China. 15. Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey.
Abstract
OBJECTIVE: To present a novel miniature endoscopic system designed to improve the safety and efficacy of percutaneous nephrolithotomy, named the 'super-mini percutaneous nephrolithotomy' (SMP). PATIENTS AND METHODS: The endoscopic system consists of a 7-F nephroscope with enhanced irrigation and a modified 10-14 F access sheath with a suction-evacuation function. This system was tested in patients with renal stones of <2.5 cm, in a multicentre prospective non-randomised clinical trial. In all, 146 patients were accrued in 14 centres. Nephrostomy tract dilatation was carried out to 10-14 F. The lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. A nephrostomy tube or JJ stent was placed only if clinically indicated. RESULTS: SMP was completed successfully in 141 of 146 patients. Five patients required conversion to larger nephrostomy tracts. The mean (sd) stone size was 2.2 (0.6) cm and the mean operative duration was 45.6 min. The initial stone-free rate (SFR) was 90.1%. The SFR at the 3-month follow-up was 95.8%. Three patients required auxiliary procedures for residual stones. Complications occurred in 12.8% of the patients, all of which were Clavien grade ≤II and no transfusions were needed. In all, 72.3% of the patients did not require any kind of catheter, while 19.8% had JJ stents and 5.7% had nephrostomy tubes placed. The mean hospital stay was 2.1 days. CONCLUSIONS: SMP is a safe and effective treatment for renal stones of <2.5 cm. SMP may be particularly suitable for patients with lower pole stones and stones that ae not amenable to retrograde intrarenal surgery.
OBJECTIVE: To present a novel miniature endoscopic system designed to improve the safety and efficacy of percutaneous nephrolithotomy, named the 'super-mini percutaneous nephrolithotomy' (SMP). PATIENTS AND METHODS: The endoscopic system consists of a 7-F nephroscope with enhanced irrigation and a modified 10-14 F access sheath with a suction-evacuation function. This system was tested in patients with renal stones of <2.5 cm, in a multicentre prospective non-randomised clinical trial. In all, 146 patients were accrued in 14 centres. Nephrostomy tract dilatation was carried out to 10-14 F. The lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. A nephrostomy tube or JJ stent was placed only if clinically indicated. RESULTS: SMP was completed successfully in 141 of 146 patients. Five patients required conversion to larger nephrostomy tracts. The mean (sd) stone size was 2.2 (0.6) cm and the mean operative duration was 45.6 min. The initial stone-free rate (SFR) was 90.1%. The SFR at the 3-month follow-up was 95.8%. Three patients required auxiliary procedures for residual stones. Complications occurred in 12.8% of the patients, all of which were Clavien grade ≤II and no transfusions were needed. In all, 72.3% of the patients did not require any kind of catheter, while 19.8% had JJ stents and 5.7% had nephrostomy tubes placed. The mean hospital stay was 2.1 days. CONCLUSIONS: SMP is a safe and effective treatment for renal stones of <2.5 cm. SMP may be particularly suitable for patients with lower pole stones and stones that ae not amenable to retrograde intrarenal surgery.