Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study

Özet

Objective: The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasisis being used as an alternative modality to the conventional PCNL. However its use in the supineposition has been scarcely reported.Material and methods: Patients who underwent ultra-mini PCNL in the supine position within the timeframe of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment.The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone sizewas less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients werepositioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequentcomplications-if any-were analyzed.Results: The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renalstone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenalstone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Medianoperative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient hadresidual fragments and needed subsequent extracorporeal shock wave lithotripsy.Conclusion: Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone diseaseis a safe method for treating low-volume disease. Studies with a larger cohort may be required to finallyvalidate this technique.