title: Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone.
abstract: OBJECTIVE
  • To evaluate the results of miniperc vis-à-vis standard PNL in the treatment of stones of 1-2 cm in size. Miniperc may represent a reasonable procedure in patients with nonbulky urolithiasis offering a similar outcome as standard percutaneous nephrolithotomy (PNL) with advantage of reduced morbidity.
  
  
  METHODS
  • 55 procedures including 27 miniperc and 28 standard PNL were performed for renal stones 1-2 cm in size. Pediatric patient, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity patients were excluded from the study. • The parameters studied were demography, operative time, postoperative analgesic requirement, hemoglobin drop, complications and stone clearance.
  
  
  RESULTS
  • Mean tract size was 18.2 ± 2 F (15-20) and 26.8 ± 2 F (24-30), P value <0.0001 in the miniperc and standard PNL, respectively. Holmium LASER and pneumatic lithotripter were the main energy sources used in miniperc and standard PNL, respectively. • Miniperc operative time was longer than that of standard PNL (45.2 ± 12.6 vs 31 ± 16.6 min, P= 0.0008 respectively). • Conversely, there was an advantage of miniperc over standard PNL in terms of a significantly reduced hemoglobin drop (0.8 ± 0.9 vs 1.3 ± 0.4 gram%, P= 0.01), analgesic requirement (55.4 ± 50 vs 70.2 ± 52 mg tramadol, P= 0.29) and hospital stay (3.2 ± 0.8 vs 4.8 ± 0.6 days, P ≤ 0.001), respectively. • Intra- operative conversion of the procedure into a tubeless PNL was significantly more in the miniperc group (P ≤ 0.001). The miniperc and standard PNL group had clearance rates of 96% and 100%, respectively at 1 month follow up.
  
  
  CONCLUSIONS
  • This study demonstrated significant advantages of the miniperc procedure in terms of reduced bleeding leading to a tubeless procedure and reduced hospital stay. • The stone free rates and the complications were similar in either group.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Shashikant
authors.initials: S
authors.lastname: Mishra
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: Chandrapraksh
authors.initials: C
authors.lastname: Garg
authors.forename: Abraham
authors.initials: A
authors.lastname: Kurien
authors.forename: Ravindra
authors.initials: R
authors.lastname: Sabnis
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D000700:Analgesics