[Minimally invasive percutaneous treatment of lower pole stones with a diameter of 8 to 15 millimeters].
OBJECTIVE
The optimal treatment options for lower pole stones with a diameter below 15 mm are controversially discussed. Extracorporeal shock wave lithotripsy (ESWL) is non-invasive but is hampered by low stone-free rates and a significant retreatment rate. Flexible ureterorenoscopy (URS) has been demonstrated to have high stone-free rates but the treatment costs - consisting of OR time, repair costs and expenditure for laser fibers, guide wires and stone baskets - as well as low stone-free rates with increasing stone size render this procedure highly expensive. Minimally invasive percutaneous litholapaxy (MIP) has shown low morbidity and high efficacy in the treatment of nephrolithiasis. The goal of this study was to investigate the efficacy and -safety of MIP for the treatment of small lower pole stones.


METHODS
The charts of 29 patients who were treated with MIP were reviewed and clinical data like OR time, drop in haemoglobin, complication rate, stone-free rate and duration of hospital stay were collected.


RESULTS
28 of 29 patients were primarily stone-free; one had to undergo additional flexible URS to become stone-free. All procedures were undertaken with only one access, no severe complications occurred; none of the patients had to be transfused.


CONCLUSIONS
The MIP concept has a low complication rate and has been shown to be safe and effective in previous studies. We demonstrate that the feasibility and efficacy justify the percutaneous approach also for small lower pole stones.
Klinik für Urologie, Universitätsklinikum Tübingen.
D
D
Schilling
G
G
Gakis
U
U
Walcher
M
M
Germann
A
A
Stenzl
Udo
U
Nagele
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome