الفهرس | Only 14 pages are availabe for public view |
Abstract Renal stone disease is one of the most common problems in urological practice. PNL is the gold standard treatment for large and complex renal stones. The techniques of PNL have developed over the last several years especially with miniaturization of instruments and optics which lead to refinement of percutaneous access techniques. Minimally invasive PNL (MIP) has been established in the treatment of small renal calculi. However, there is an ongoing debate whether MIP can safely and effectively be applied in the treatment of larger sized renal calculi. This is a prospective clinical study. It was done in two tertiary centers; in Assiut, Egypt and Tuebingen, Germany. The goal of this study was to evaluate the efficacy and safety of MIP in management of large renal stones and to compare its outcomes with those of the conventional PNL. One hundred fifty patients with 165 renal units were included in the study, divided into two groups; Assiut group underwent conventional PNL (42 procedure) and Tuebingen group underwent MIP (123 procedure). All the stones were larger than 2cm. The primary success rate was 76.4% and 61.9% for MIP and conventional groups respectively with no significant difference. While after an auxiliary procedure the stone free rate reaches 94.3% and 92.8% for both groups respectively. Stone burden and number of tracts were found to be independent factors determining the primary success rate of MIP. Percentage of complications was 19.5% and 33.3% for MIP and conventional PNL groups respectively with no significant difference. Most of the complications encountered in both maneuvers were of minor grade and were managed conservatively (grade I and II modified Clavien Summary 99 grading). Blood transfusion was required in conventional PNL patients significantly more frequently than MIP group (p<0.001). Intraoperative time was 101 and 100 minutes for MIP group and the conventional group respectively. Duration of hospital stay was 4.3 and 4.9 days for MIP group and the conventional group respectively. An important factor that might explain these outcomes is that the mean stone burden for conventional PNL group (62.2 ± 38.5) was significantly higher than that of MIP group (38.7 ± 23.4mm) (P<0.001). Superiority of one technique over the other cannot be concluded from the study. Further prospective randomized studies with large sample size should be encouraged to ensure these preliminary results. |