Objective:To evaluate the safety,efficacy and feasibility of laser with suction device in mini-percutaneous nephrolithotomy(mini-PCNL).Methods:A retrospective study was conducted including 200 patients who underwent m...Objective:To evaluate the safety,efficacy and feasibility of laser with suction device in mini-percutaneous nephrolithotomy(mini-PCNL).Methods:A retrospective study was conducted including 200 patients who underwent mini-PCNL for renal stones.All patients underwent PCNL using Electro-Medical Systems laser.In addition to the laser in 100 patients,a suction device was used(laser with suction[LWS]).In the other 100,suction device was not used(laser with no additional suction[LOS]).Mini-PCNL was performed using standard technique and Karl Storz minimally invasive PCNL-medium system was used.Primary end point was stone clearance.Results:Both the groups were comparable in terms of demographic data.Mean stone size was 15.24±5.90 mm and 16.16±5.53 mm in LWS and LOS,respectively.Mean Hounsfield unit of stone was 1285.64 and 1206.79 in LWS and LOS,respectively.Operative time was less in LWS group(56.89±19.65 min)as compared to LOS(62.01±28.81 min).At one-month follow-up,radiological complete clearance was 96%in LWS and 92%in LOS.On subgroup analysis of stones larger than 18 mm,the clearance rate was in favour of LWS(85.7%vs.100%)and also the need for nephrostomy placement was less in LWS group.Conclusions:LWS device is safe and efficacious when used with mini-PCNL.For stones greater than 18 mm,it has a better stone free rate as compared to using no suction.展开更多
Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy ...Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.展开更多
Background Flexible ureterorenoscopy(fURS)and mini-percutaneous nephrolithotomy(mPCNL)have been increasingly used for the treatment of renal stones.However,current guidelines do not recommend one modality over the oth...Background Flexible ureterorenoscopy(fURS)and mini-percutaneous nephrolithotomy(mPCNL)have been increasingly used for the treatment of renal stones.However,current guidelines do not recommend one modality over the other.The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.Materials and methods A prospective,randomized,comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers.Inclusion criteria were adult patients with renal stone(s)≤2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy.Subjects were assigned to 1 of 2 treatment groups,either mPCNL or fURS.Two primary outcomes were assessed:(1)initial success rate,defined as the absence of clinically significant residual fragments(>2 mm)on kidney ureter bladder X-ray and ultrasound on the first postoperative day;and(2)complications,which were reported according to the Modified Clavien-Dindo classification system.Secondary outcomes included final success rate,defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day;operative time;auxiliary procedures and blood transfusion rates;hemoglobin drop;and length of hospital stay.Results One hundred and eighteen procedures were analyzed(59 in each group).The initial success rate of the mPCNL group(93%)was significantly higher than that of the fURS group(70%).Complications occurred more frequently with mPCNL than fURS(44.1%vs.18.6%,respectively).Final success rate,operative time,and length of hospital stay were comparable between the 2 groups.Conclusions Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones<2 cm because of its higher initial success rate and lower auxiliary procedure rate.However,mPCNL results in significantly higher complication rates than fURS.展开更多
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-f...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.展开更多
Objective:To summarize recent advancements in mini-percutaneous nephrolithotomy(mini-PCNL)in surgical technique,stone removal strategy,lithotripsy,and surgical model from the current literature.Methods:We conducted a ...Objective:To summarize recent advancements in mini-percutaneous nephrolithotomy(mini-PCNL)in surgical technique,stone removal strategy,lithotripsy,and surgical model from the current literature.Methods:We conducted a narrative review of relevant English-language articles up to October 2022 using the PubMed and Web of Science databases.The following keywords were used in the search:“percutaneous nephrolithotomy”,“minimally invasive percutaneous nephrolithotomy”,“mini-PCNL”,“mini-perc”,“mPCNL”,and“miniaturization”.Results:A series of new progress has been made in many aspects of mini-PCNL,such as further reduction of tract sizedneedle perc and further improvement of robotic-assisted PCNLdartificial intelligence-powered robotic devices.Conclusion:Many studies and trials have been conducted to reduce morbidity and increase the safety and effectiveness of mini-PCNL.It is crucial to realize that miniaturization of PCNL requires not only a smaller percutaneous tract size,but also an adjustment strategically in renal access,stone removal,lithotripsy,and surgical model in general.More large-scale prospective research needs to be carried out to further validate and optimize the safety and effectiveness of mini-PCNL.展开更多
文摘Objective:To evaluate the safety,efficacy and feasibility of laser with suction device in mini-percutaneous nephrolithotomy(mini-PCNL).Methods:A retrospective study was conducted including 200 patients who underwent mini-PCNL for renal stones.All patients underwent PCNL using Electro-Medical Systems laser.In addition to the laser in 100 patients,a suction device was used(laser with suction[LWS]).In the other 100,suction device was not used(laser with no additional suction[LOS]).Mini-PCNL was performed using standard technique and Karl Storz minimally invasive PCNL-medium system was used.Primary end point was stone clearance.Results:Both the groups were comparable in terms of demographic data.Mean stone size was 15.24±5.90 mm and 16.16±5.53 mm in LWS and LOS,respectively.Mean Hounsfield unit of stone was 1285.64 and 1206.79 in LWS and LOS,respectively.Operative time was less in LWS group(56.89±19.65 min)as compared to LOS(62.01±28.81 min).At one-month follow-up,radiological complete clearance was 96%in LWS and 92%in LOS.On subgroup analysis of stones larger than 18 mm,the clearance rate was in favour of LWS(85.7%vs.100%)and also the need for nephrostomy placement was less in LWS group.Conclusions:LWS device is safe and efficacious when used with mini-PCNL.For stones greater than 18 mm,it has a better stone free rate as compared to using no suction.
文摘Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.
文摘Background Flexible ureterorenoscopy(fURS)and mini-percutaneous nephrolithotomy(mPCNL)have been increasingly used for the treatment of renal stones.However,current guidelines do not recommend one modality over the other.The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.Materials and methods A prospective,randomized,comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers.Inclusion criteria were adult patients with renal stone(s)≤2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy.Subjects were assigned to 1 of 2 treatment groups,either mPCNL or fURS.Two primary outcomes were assessed:(1)initial success rate,defined as the absence of clinically significant residual fragments(>2 mm)on kidney ureter bladder X-ray and ultrasound on the first postoperative day;and(2)complications,which were reported according to the Modified Clavien-Dindo classification system.Secondary outcomes included final success rate,defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day;operative time;auxiliary procedures and blood transfusion rates;hemoglobin drop;and length of hospital stay.Results One hundred and eighteen procedures were analyzed(59 in each group).The initial success rate of the mPCNL group(93%)was significantly higher than that of the fURS group(70%).Complications occurred more frequently with mPCNL than fURS(44.1%vs.18.6%,respectively).Final success rate,operative time,and length of hospital stay were comparable between the 2 groups.Conclusions Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones<2 cm because of its higher initial success rate and lower auxiliary procedure rate.However,mPCNL results in significantly higher complication rates than fURS.
基金financed by a grant from the National Natural Science Foundation of China(Nos.81670643 and 81370804)the Science and Technology Program of Guangzhou,China(No.201604020001).
文摘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.
文摘Objective:To summarize recent advancements in mini-percutaneous nephrolithotomy(mini-PCNL)in surgical technique,stone removal strategy,lithotripsy,and surgical model from the current literature.Methods:We conducted a narrative review of relevant English-language articles up to October 2022 using the PubMed and Web of Science databases.The following keywords were used in the search:“percutaneous nephrolithotomy”,“minimally invasive percutaneous nephrolithotomy”,“mini-PCNL”,“mini-perc”,“mPCNL”,and“miniaturization”.Results:A series of new progress has been made in many aspects of mini-PCNL,such as further reduction of tract sizedneedle perc and further improvement of robotic-assisted PCNLdartificial intelligence-powered robotic devices.Conclusion:Many studies and trials have been conducted to reduce morbidity and increase the safety and effectiveness of mini-PCNL.It is crucial to realize that miniaturization of PCNL requires not only a smaller percutaneous tract size,but also an adjustment strategically in renal access,stone removal,lithotripsy,and surgical model in general.More large-scale prospective research needs to be carried out to further validate and optimize the safety and effectiveness of mini-PCNL.
