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| Miniaturised percutaneous nephrolithotomy: Its role in the treatment of urolithiasis and our experience |
Guohua Zengab*( ),Wei Zhuab,Wayne Lamc
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a. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
b. Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, Guangzhou, China
c. Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong, China |
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Abstract Miniaturized percutaneous nephrolithotomy (PCNL) procedures have gained increased popularity in recent years. They aim to reduce percutaneous tract size in order to lower complication rates, while maintaining high stone-free rates. Recently, miniaturized PCNL techniques have further expanded, and can currently be classified into mini-PCNL, minimally invasive PCNL (MIP), Chinese mini-PCNL (MPCNL), ultra-mini-PCNL (UMP), micro-PCNL, mini-micro-PCNL, and super-mini-PCNL (SMP). However, despite its minimally-invasive nature, its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate. The aim of this review is to summarise different available modalities of miniaturized PCNL, details of instruments involved, and their corresponding safety and efficacy. In particular, this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis. Overall, miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients. Well-designed, randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.
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Received: 21 November 2017
Published: 19 November 2018
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| Fund:This work was financed by a grant from the National Natural Science Foundation of China(81670643);This work was financed by a grant from the National Natural Science Foundation of China(81370804);the Science and TechnologyProgram of Guangzhou, China(201604020001) |
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Corresponding Authors:
Zeng Guohua
E-mail: gzgyzgh@vip.sina.com
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| Term | Access sheath (Fr) | References | | Mini-PCNL | ≤22 | Jackman et al. [6] | | Minimally invasive PCNL | 9.5-26.0 | Nagele et al. [8] | | Chinese mini-PCNL | 14-20 | Li et al. [9] | | Ultra-mini PCNL | 11-13 | Desai et al. [10] | | Micro-PCNL | 4.8 | Desai and Mishra. [11] | | Mini-micro-PCNL | 8 | Desai et al. [12] | | Super-mini-PCNL | 10-14 | Zeng et al. [13] |
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| First-generation SMP (n = 9) | New-generation SMP (n = 38) | p value | | Basic RPP (mmHg, mean ± SD) | 8.9 ± 4.0 | 10.7 ± 3.4 | 0.178 | | Intraoperative RPP (mmHg, mean ± SD) | 14.0 ± 5.6 | 21.3 ± 10.2 | <0.001 | | Number of patients who had one episode of RPP ≥ 30 mmHg | 7/9 | 30/38 | 0.938 | | Accumulated time of RPP ≥ 30 mmHg (s, mean ± SD) | 14.3 ± 18.0 | 92.3 ± 88.4 | <0.001 |
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New-generation super-mini-percutaneous nephrolithotomy system.
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The working sheath used in the first- and the new-generation super-mini-percutaneous nephrolithotomy system [35].
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The hydrodynamic mechanisms for retrieval fragments in the first- and new-generation percutaneous nephrolithotomy systems [35].
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| [1] |
Fernström I, Johansson B . Percutaneous pyelolithotomy. Anew extraction technique. Scand J Urol Nephrol 1976; 10:257e9.
pmid: 1006190
|
| [2] |
Xue W, Pacik D, Boellaard W, Breda A, Botoca M, Rassweiler J , et al. Management of single large nonstaghorn renal stones inthe CROES PCNL global study. J Urol 2012; 187:1293e7.
doi: 10.1016/j.juro.2011.11.113
pmid: 22341292
|
| [3] |
Zhu W, Liu Y, Liu L, Lei M, Yuan J, Wan SP , et al. Minimallyinvasive versus standard percutaneous nephrolithotomy: ameta-analysis. Urolithiasis 2015; 43:563e70.
|
| [4] |
Armitage JN, Irving SO, Burgess NA , British Association ofUrological Surgeons Section of Endourology. Percutaneousnephrolithotomy in the United Kingdom: results of a prospectivedata registry. Eur Urol 2012; 61:1188e93.
|
| [5] |
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R , et al. The Clinical Research Office of the EndourologicalSociety percutaneous nephrolithotomy global study:indications, complications, and outcomes in 5803 patients. JEndourol 2011; 25:11e7.
|
| [6] |
Jackman SV, Hedican SP, Peters CA, Docimo SG . Percutaneousnephrolithotomy in infants and preschool age children:experience with a new technique. Urology 1998; 52:697e701.
doi: 10.1016/S0090-4295(98)00315-X
pmid: 9763096
|
| [7] |
Lahme S, Bichler KH, Strohmaier WL, Götz T . Minimally invasivePCNL in patients with renal pelvic and calyceal stones. Eur Urol 2001; 40:619e24.
doi: 10.1159/000049847
pmid: 11805407
|
| [8] |
Nagele U, Horstmann M, Sievert K-D, Kuczyk MA, Walcher U, Hennenlotter J , et al. A newly designed amplatz sheath decreasesintrapelvic irrigation pressure during minipercutaneousnephrolitholapaxy: an in-vitro pressure-measurementand microscopic study. J Endourol 2007; 21:1113e6.
doi: 10.1089/end.2006.0230
pmid: 17941796
|
| [9] |
Li X, He Z, Wu K, Li SK, Zeng G, Yuan J , et al. Chinese minimallyinvasive percutaneous nephrolithotomy: the Guangzhouexperience. J Endourol 2009; 23:1693e7.
doi: 10.1089/end.2009.1537
pmid: 19747032
|
| [10] |
Desai J, Zeng G, Zhao Z, Zhong W, Chen W , Wu W. A noveltechnique of ultra-mini-percutaneous nephrolithotomy:introduction and an initial experience for treatment of upperurinary calculi less than 2 cm. BioMed Res Int 2013; 2013. .
|
| [11] |
Desai M, Mishra S . “Microperc” micro percutaneous nephrolithotomy:evidence to practice. Curr Opin Urol 2012; 22:134e8.
|
| [12] |
Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S, Vyas J, Jagtap J , et al. Current role of microperc in the managementof small renal calculi. Indian J Urol IJU J Urol Soc India 2013; 29:214e8.
doi: 10.4103/0970-1591.117282
pmid: 24082443
|
| [13] |
Zeng G, Wan S, Zhao Z, Zhu J, Tuerxun A, Song C , et al. Superminipercutaneous nephrolithotomy (SMP): a new concept intechnique and instrumentation. BJU Int 2016; 117:655e61.
doi: 10.1111/bju.13242
pmid: 26220396
|
| [14] |
Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW . The “mini-perc” technique: a less invasive alternativeto percutaneous nephrolithotomy. World J Urol 1998; 16:371e4.
doi: 10.1007/s003450050083
pmid: 9870281
|
| [15] |
Hu G, Guo Z, Liu H, Luo M, Liu M, Lai P , et al. A novel minimallyinvasive percutaneous nephrolithotomy technique:safety and efficacy report. Scand J Urol 2015; 49:174e80.
doi: 10.3109/21681805.2014.961545
pmid: 25247463
|
| [16] |
Jiang H, Yu Z, Chen L, Wang T, Liu Z, Liu J, et al. Minimallyinvasive percutaneous nephrolithotomy versus retrogradeintrarenal surgery for upper urinary stones: a systematicreview and meta-analysis. BioMed Res Int 2017; 2017:2035851.
|
| [17] |
Mager R, Balzereit C, Gust K, Hüsch T, Herrmann T, Nagele U , et al. The hydrodynamic basis of the vacuum cleaner effect incontinuous-flow PCNL instruments: an empiric approach andmathematical model. World J Urol 2016; 34:717e24.
doi: 10.1007/s00345-015-1682-5
pmid: 26358036
|
| [18] |
Abdelhafez MF, Bedke J, Amend B, ElGanainy E, Aboulella H, Elakkad M, et al.Minimally invasive percutaneous nephrolitholapaxy(PCNL) as an effective and safe procedure forlarge renal stones: minimally invasive PCNL for large renalstones. BJU Int 2012; 110:E1022e6.
|
| [19] |
Kruck S, Anastasiadis AG, Herrmann TRW, Walcher U, Abdelhafez MF, Nicklas AP , et al. Minimally invasive percutaneousnephrolithotomy: an alternative to retrograde intrarenalsurgery and shockwave lithotripsy. World J Urol 2013; 31:1555e61.
doi: 10.1007/s00345-012-0962-6
pmid: 23064981
|
| [20] |
Hennessey DB, Kinnear NK, Troy A, Angus D, Bolton DM, Webb DR . Mini PCNL for renal calculi: does size matter? BJUInt 2017; 119:39e46.
doi: 10.1111/bju.13839
pmid: 28544299
|
| [21] |
Zeng G, Mai Z, Zhao Z, Li X, Zhong W, Yuan J , et al. Treatmentof upper urinary calculi with Chinese minimally invasivepercutaneous nephrolithotomy: a single-center experiencewith 12,482 consecutive patients over 20 years. Urolithiasis2013; 41:225e9.
doi: 10.1007/s00240-013-0561-z
pmid: 2361618020
|
| [22] |
Zeng G, Zhao Z , ZhongW,Wu K, ChenW,WuW, et al. Evaluationof a novel fascial dilator modified with scale marker in percutaneousnephrolithotomy for reducing the X-ray exposure: arandomized clinical study. J Endourol 2013; 27:1335e40.
doi: 10.1016/j.juro.2013.02.3039
pmid: 23527890
|
| [23] |
Zeng G, Zhong W, Li X, Chen W, He Y, He Z . The influence ofminimally invasive percutaneous nephrolithotomy on renalpelvic pressure in vivo. Surg Laparosc Endosc PercutaneousTech 2007; 17:307e10.
doi: 10.1097/SLE.0b013e31806e61f4
pmid: 17710055
|
| [24] |
Zeng G, Zhao Z, Wan S, Mai Z, Wu W, Zhong W , et al. Minimallyinvasive percutaneous nephrolithotomy for simple and complexrenal caliceal stones: a comparative analysis of morethan 10,000 cases. J Endourol 2013; 27:1203e8.
doi: 10.1089/end.2013.0061
pmid: 3787398
|
| [25] |
Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y . Minimallyinvasive tract in percutaneous nephrolithotomy for renalstones. J Endourol 2010; 24:1579e82.
doi: 10.1089/end.2009.0581
pmid: 20839954
|
| [26] |
Zhong W, Zeng G, Wu W, Chen W, Wu K . Minimally invasivepercutaneous nephrolithotomy with multiple mini tracts in asingle session in treating staghorn calculi. Urol Res 2011; 39:117e22.
doi: 10.1007/s00240-010-0308-z
pmid: 20821200
|
| [27] |
Zeng G, Zhu W, Li J, Zhao Z, Zeng T, Liu C , et al. The comparisonof minimally invasive percutaneous nephrolithotomyand retrograde intrarenal surgery for stones larger than 2 cmin patients with a solitary kidney: a matched-pair analysis. World J Urol 2015; 33:1159e64.
|
| [28] |
Wu W, Zhao Z, Zhu H, Yang D, Ou L, Liang Y , et al. Safety andefficacy of minimally invasive percutaneous nephrolithotomyin treatment of calculi in horseshoe kidneys. J Endourol 2014; 28:926e9.
doi: 10.1089/end.2013.0760
pmid: 24716526
|
| [29] |
Desai J, Solanki R . Ultra-mini percutaneous nephrolithotomy(UMP): one more armamentarium: ultra-mini PCNL. BJU Int2013; 112:1046e9.
|
| [30] |
Agrawal MS, Agarwal K, Jindal T, Sharma M . Ultra-minipercutaneousnephrolithotomy: a minimally-invasive optionfor percutaneous stone removal. Indian J Urol IJU J Urol SocIndia 2016; 32:132e6.
doi: 10.4103/0970-1591.174778
pmid: 27127356
|
| [31] |
An overview of percutaneous nephrolithotomy. Eur Med J 2015. .[Accessed 11 October 2017].
|
| [32] |
Wilhelm K, Hein S, Adams F, Schlager D, Miernik A, Schoenthaler M . Ultra-mini PCNL versus flexible ureteroscopy:a matched analysis of analgesic consumption and treatmentrelatedpatient satisfaction in patients with renal stones 10-35 mm. World J Urol 2015; 33:2131e6.
doi: 10.1007/s00345-015-1585-5
pmid: 25971205
|
| [33] |
Hatipoglu NK, Tepeler A, Buldu I, Atis G, Bodakci MN, Sancaktutar AA , et al. Initial experience of micropercutaneousnephrolithotomy in the treatment of renalcalculi in 140 renal units. Urolithiasis 2014; 42:159e64.
doi: 10.1007/s00240-013-0631-2
pmid: 2433764620
|
| [34] |
Wright A, Rukin N, Smith D , De la Rosette J, Somani BK. “Mini,ultra, micro” e nomenclature and cost of these new minimallyinvasive percutaneous nephrolithotomy (PCNL) techniques. Ther Adv Urol 2016; 8:142e6.
|
| [35] |
Zeng G, Zhu W, Liu Y, Fan J, Lam W, Lan Y , et al. Prospectivecomparative study of the efficacy and safety of newgenerationversus first-generation system for super-minipercutaneousnephrolithotomy: a revolutionary approach toimprove endoscopic vision and stone removal. J Endourol2017; 31:1157e63.
doi: 10.1089/end.2017.0558
pmid: 28895477
|
| [36] |
Unsal A, Resorlu B . Retrograde intrarenal surgery in infantsand preschool-age children. J Pediatr Surg 2011; 46:2195e9.
doi: 10.1016/j.jpedsurg.2011.07.013
pmid: 22075358
|
| [37] |
KimSS, Kolon TF, Canter D, White M, Casale P . Pediatric flexibleureteroscopic lithotripsy: the children’s hospital of Philadelphiaexperience. J Urol 2008; 180:2616e9.
doi: 10.1016/j.juro.2008.08.051
pmid: 18950810
|
| [38] |
Liu Y, Wu W, Tuerxun A, Liu Y, Simayi A, Huang J , et al. Superminipercutaneous nephrolithotomy in the treatment of pediatricnephrolithiasis: evaluation of the initial results. JEndourol 2017; 31:S38e42.
doi: 10.1089/end.2016.0572
pmid: 27819138
|
| [39] |
Zeng G, Zhu W, Liu Y, Fan J, Zhao Z, Cai C . The new generationsuper-mini percutaneous nephrolithotomy (SMP) system:a step-by-step guide. BJU Int 2017; 120:735e8.
doi: 10.1111/bju.13955
pmid: 28692204
|
| [40] |
Liu Y, AlSmadi J, Zhu W, Liu Y, Wu W, Fan J , et al. Comparisonof super-mini PCNL ( SMP) versus Miniperc for stones largerthan 2 cm: a propensity score-matching study. World J Urol2018. .
|
| [41] |
Sarica K, Eryildirim B, Tuerxun A, Batuer A, Kavukoglu O, Buz A , et al. Super-mini percutaneous nephrolithotomy forrenal stone less than 25 mm in pediatric patients: could it bean alternative to shockwave lithotripsy? Actas Urol Esp 2017..
|
| [42] |
K?l?ç Ö, Akand M, Van Cleynenbreugel B . Retrograde intrarenalsurgery for renal stones e Part 2. Turk J Urol 2017; 43:252e60.
doi: 10.5152/tud.2017.03708
pmid: 28717532
|
|
|
|
