title: The role of microperc in the treatment of symptomatic lower pole renal calculi.
abstract: OBJECTIVE
  The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi.
  
  
  METHODS
  We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F "all-seeing needle" with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 μm holmium:yttrium-aluminum-garnet laser fiber.
  
  
  RESULTS
  A total of 21 patients (mean age 37.3 ± 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 ± 6.0 kg/m(2), and the mean stone size was 17.8 ± 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 ± 25.2 minutes and 150.5 ± 92.8 seconds, respectively. The patients were discharged after a mean 37.5 ± 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 ± 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe.
  
  
  CONCLUSIONS
  Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. akadirtepeler@yahoo.com
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armagan
authors.forename: Ahmet Ali
authors.initials: AA
authors.lastname: Sancaktutar
authors.forename: Mesrur Selcuk
authors.initials: MS
authors.lastname: Silay
authors.forename: Necmettin
authors.initials: N
authors.lastname: Penbegul
authors.forename: Tolga
authors.initials: T
authors.lastname: Akman
authors.forename: Namık Kemal
authors.initials: NK
authors.lastname: Hatipoglu
authors.forename: Cevper
authors.initials: C
authors.lastname: Ersoz
authors.forename: Mehmet Remzi
authors.initials: MR
authors.lastname: Erdem
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Akcay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000535:Aluminum / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods; D055815:Young Adult; D015019:Yttrium / Q000627:therapeutic use*
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum