Munich, Germany (UroToday.com) In order to decrease percutaneous nephrolithotomy (PCNL) morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed.
This is performed with a miniature endoscope via a small percutaneous tract (11–20 F) and was named as minimally invasive PCNL or mini-PCNL or mini Perc. Data and colleagues performed a prospectively randomized trial to compare ultra mini PCNL (UMP) and Retrograde Intra-Renal Surgery (RIRS) in a Randomised Controlled Trial (RCT).
Inclusion criteria were 1-3cm stones with no history of bleeding diathesis and screened for infection.
A total of 150 patients were randomized into two groups, UMP (101) or RIRS (48) between 2014 and 2015. There was no difference in mean stone size between the two groups. 1 month stone free was defined as absence of calcification on CT KUB. 11 UMP and 6 RIRS patients did not attend for 1 month CT scan.
Mean operating time was 41 minutes for UMP group compared to 74 minutes for RIRS (p<0.0001). No patient who had UMP required a second procedure compared to RIRS, which had 47 patients (97.9%) who required stent removal under flexible cystoscopy. Nephrostomy was required in 22% of the UMP patients, and none of the RIRS patients.
Primary outcome of the study was stone free rate intraoperatively and at 1 month which demonstrated 99% and 100% in the UMP group and the RIRS group was 2% and 71% (1-month CT, p<0.001). The Clavien-Dindo complication rate was 10% (UMP) and 33% (RIRS) (p=0.0009) with all being grades 1-2. Mean consumable costs in UMP were US$ 46 and in RIRS $423 (p<0.0001).
In conclusion, Dr. Datta stated that UMP has a superior stone free rate and fewer complications compared to RIRS in the treatment of 1-3cm stones.
Presented By:
Datta S.
Colchester Hospital University NHS Foundation Trust, Dept. of Urology, Colchester, United Kingdom
Reported by
Zhamshid Okhunov, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
UC Irvine Urology