Therapeutic and safety evaluation of third-generation super-mini percutaneous nephrolithotomy in treating ≤ 2.5 cm kidney calculi with high CT value_West China Medical Journal

Authors：

 CHEN Bing , HU Zhenxing , LIU Cong , YU Hejiang , WEI Fanjie , YU Rui , ZHOU Wenjie

Department of Urology, the People’s Hospital of Leshan Central District, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

CHEN Bing, Email: 379037776@qq.com

Keywords：

Super-mini percutaneous nephrolithotomy; Mini percutaneous nephrolithotomy; Kidney calculi; Tubeless

DOI：

10.7507/1002-0179.201904212

Video：

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Objective To evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy (SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals.Methods The clinical data of 64 patients with unilateral kidney calculi (CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People’s Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy (MPCNL). The pre-, intra-, and post-operative data were compared and analyzed to evaluate the efficacy and safety.Results The unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups (P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs. (25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs. (9.44±0.96) days], rate of indwelling renal fistula (3.3% vs. 50.0%), analgesic demand rate (10.0% vs. 58.8%), and postoperative infectious fever rate (6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant (P<0.05).Conclusions SMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.

Citation： CHEN Bing, HU Zhenxing, LIU Cong, YU Hejiang, WEI Fanjie, YU Rui, ZHOU Wenjie. Therapeutic and safety evaluation of third-generation super-mini percutaneous nephrolithotomy in treating ≤ 2.5 cm kidney calculi with high CT value. West China Medical Journal, 2019, 34(7): 796-800. doi: 10.7507/1002-0179.201904212 Copy

1.	Altunrende F, Tefekli A, Stein RJ, et a1. Clinically insignificant residual fragments after percutaneous nephrolithotomy: medium-term follow-up. J Endourol, 2011, 25(6): 941-945.
2.	中华医学会重症医学分会. 中国严重脓毒血症/脓毒性休克治疗指南(2014). 中华内科学杂志, 2015, 54(6): 557-581.
3.	Watterson JD, Soon S, Jana K, et al. Access related complications during percutaneous nephrolithotomy: urology versus radiology at a single academic institution. J Urol, 2006, 176(1): 142-145.
4.	韦巍, 黄剑华, 钟羽翔, 等. 2~3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值. 中华腔镜泌尿外科杂志(电子版), 2019, 13(2): 95-98.
5.	Kamal W, Kallidonis P, Kyriazis I, et al. Minituriazed percutaneous nephrolithotomy: what does it mean?. Urolithiasis, 2016, 44(3): 195-201.
6.	郭景阳, 杨文增, 张彦桥, 等. 斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察. 中国内镜杂志, 2017, 23(4): 95-97.
7.	Bader MJ, Gratzke C, Seitz M, et al. The " all-seeing needle”: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol, 2011, 59(6): 1054-1059.
8.	Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol, 2011, 186(1): 140-145.
9.	Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int, 2013, 112(7): 1046-1049.
10.	Wright A, Rukin N, Smith D, et al. " Mini, ultra, micro” - nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy (PCNL) techniques. Ther Adv Urol, 2016, 8(2): 142-146.
11.	Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation. BJU Int, 2016, 117(4): 655-661.
12.	詹鹰, 张宇聪, 王康扬, 等. 超微经皮肾镜在上尿路结石治疗中的临床应用(附13例报告). 临床泌尿外科杂志, 2017, 32(2): 141-143.
13.	王亚园, 许长宝, 褚校涵, 等. 超微经皮肾镜与输尿管软镜治疗直径2-3 cm高CT值肾结石疗效对比. 实用医学杂志, 2018, 34(18): 2181-2183.
14.	Liu Y, AlSmadi J, Zhu W, et al. Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: a propensity score-matching study. World J Urol, 2018, 36(6): 955-961.
15.	Cai C, Liu Y, Zhong W, et al. The clinical application of new generation super-mini percutaneous nephrolithotomy in the treatment of ≥20 mm renal stones. J Endourol, 2019.
16.	Zeng G, Zhu W, Lam W. Miniaturised percutaneous nephrolithotomy: its role in the treatment of urolithiasis and our experience. Asian J Urol, 2018, 5(4): 295-302.
17.	Tepeler A, Armagan A, Sancaktutar AA, et al. The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol, 2013, 27(1): 13-18.
18.	曾国华, 万肖蓬, 陈文忠, 等. 超微经皮肾镜取石术治疗31例肾结石的初步体会. 中华泌尿外科杂志, 2014, 35(1): 6-9.
19.	Sebaey A, Khalil MM, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: a randomised controlled trial. Arab J Urol, 2016, 14(1): 18-23.

1. Altunrende F, Tefekli A, Stein RJ, et a1. Clinically insignificant residual fragments after percutaneous nephrolithotomy: medium-term follow-up. J Endourol, 2011, 25(6): 941-945.
2. 中华医学会重症医学分会. 中国严重脓毒血症/脓毒性休克治疗指南(2014). 中华内科学杂志, 2015, 54(6): 557-581.
3. Watterson JD, Soon S, Jana K, et al. Access related complications during percutaneous nephrolithotomy: urology versus radiology at a single academic institution. J Urol, 2006, 176(1): 142-145.
4. 韦巍, 黄剑华, 钟羽翔, 等. 2~3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值. 中华腔镜泌尿外科杂志(电子版), 2019, 13(2): 95-98.
5. Kamal W, Kallidonis P, Kyriazis I, et al. Minituriazed percutaneous nephrolithotomy: what does it mean?. Urolithiasis, 2016, 44(3): 195-201.
6. 郭景阳, 杨文增, 张彦桥, 等. 斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察. 中国内镜杂志, 2017, 23(4): 95-97.
7. Bader MJ, Gratzke C, Seitz M, et al. The " all-seeing needle”: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol, 2011, 59(6): 1054-1059.
8. Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol, 2011, 186(1): 140-145.
9. Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int, 2013, 112(7): 1046-1049.
10. Wright A, Rukin N, Smith D, et al. " Mini, ultra, micro” - nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy (PCNL) techniques. Ther Adv Urol, 2016, 8(2): 142-146.
11. Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation. BJU Int, 2016, 117(4): 655-661.
12. 詹鹰, 张宇聪, 王康扬, 等. 超微经皮肾镜在上尿路结石治疗中的临床应用(附13例报告). 临床泌尿外科杂志, 2017, 32(2): 141-143.
13. 王亚园, 许长宝, 褚校涵, 等. 超微经皮肾镜与输尿管软镜治疗直径2-3 cm高CT值肾结石疗效对比. 实用医学杂志, 2018, 34(18): 2181-2183.
14. Liu Y, AlSmadi J, Zhu W, et al. Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: a propensity score-matching study. World J Urol, 2018, 36(6): 955-961.
15. Cai C, Liu Y, Zhong W, et al. The clinical application of new generation super-mini percutaneous nephrolithotomy in the treatment of ≥20 mm renal stones. J Endourol, 2019.
16. Zeng G, Zhu W, Lam W. Miniaturised percutaneous nephrolithotomy: its role in the treatment of urolithiasis and our experience. Asian J Urol, 2018, 5(4): 295-302.
17. Tepeler A, Armagan A, Sancaktutar AA, et al. The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol, 2013, 27(1): 13-18.
18. 曾国华, 万肖蓬, 陈文忠, 等. 超微经皮肾镜取石术治疗31例肾结石的初步体会. 中华泌尿外科杂志, 2014, 35(1): 6-9.
19. Sebaey A, Khalil MM, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: a randomised controlled trial. Arab J Urol, 2016, 14(1): 18-23.

West China Medical Journal

Therapeutic and safety evaluation of third-generation super-mini percutaneous nephrolithotomy in treating ≤ 2.5 cm kidney calculi with high CT value

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