Presentation Authors: Belthangady Monu Zeeshan Hameed*, Arun Chawla, Manjunath Venkatachaliah, Manipal, India
Introduction: Percutaneous Nephrolithotomy (PCNL) has been widely performed procedure for the management renal stones. Standard PCNL is usually performed through 24- to 30-Fr percutaneous tracts. Several reports have suggested that the risk of bleeding is associated with Amplatz sheath size. To decrease the morbidity related to larger tracts such as bleeding, postoperative pain, and potential renal damage; modifications to the size of the instruments have been made. The miniature version of mini PCNL i.e., Mini Micro PCNL(MMP) using 8.5/9.5F sheath and 7.5Fr nephroscope has been developed for the treatment of renal calculi of size 1-2cm. We intend to validate the safety, efficacy, and applicability of Mini-Micro PCNL in our study.
Methods: We prospectively evaluated the outcomes of Mini-Micro PCNL in a single surgeon, single center study. Data of 40 patients who underwent Mini-Micro PCNL from May 2016 to December 2017 were evaluated. Patients were assessed on 1st month and at 3rd month postoperatively by X ray/ CT KUB to assess stone free status.
Results: The mean age of the patients was 43.43 years (20-77 years). The mean BMI was 28.3 Kg/m2. The Mean stone size was 15.13 mm. 22 patients had calculus size of 1.2 -1.5 cm, 18 patients had calculus size of 1.6- 2 cm. The position of the calculus were in upper calyx (N= 2), middle calyx (N= 5), lower calyx (N= 9), pelvic (N= 20) and pelvi-ureteric junction (N= 4). Access was achieved through superior calyx (N= 19) middle (N= 13) and lower (N= 13). The Mean operative time (the puncture of kidney to removal of outer sheath after completion of fragmentation) was 40.48 mins (Range 17- 70 mins). Mean haemoglobin loss was 0.663 gm /dl. Mean creatinine increase was 0.07 mg/dl. There were no blood transfusions. Grade 1 Clavein Dindo complication i.e., fever was seen in 7 cases. 5 patients had low grade fever (99-100F) for 6-8hrs, 2 patients had moderate fever (100-103F). Post operatively single dose, parental analgesia i.e., aqueous diclofenac 75 mg was given in the early hours post operatively (0-4 hours) in 82.5% patients after measuring pain statically and dynamically. Mean length of hospital stay was 36.35 hours (Range 25 â€“ 84 hours). DJ stenting was done in all patients which was removed after 1 month. Stone free rate was 90% at 1st month, 100% at 3rd month postoperatively.
Conclusions: Mini-Micro PCNL is a safe and efficacious technique in the management of renal calculi of size < 2 cm. This procedure can be recommended as it gives excellent stone free status, reduced analgesic requirements, early post op recovery and is cost effective.