title: Implementation of Ultramini Percutaneous Nephrolithotomy for Treatment of 2-3 cm Kidney Stones: A Preliminary Report.
abstract: OBJECTIVE
  Miniatured percutaneous nephrolithotomy (PCNL) techniques such as micro-PCNL (microperc) and ultramini-PCNL (UMP) are usually indicated for renal stones <2 cm. We present our preliminary report of treating patients with 2 to 3 cm renal stones using UMP in a semisupine combined lithotomy position associated with a retrograde ureteral access sheath (UAS).
  
  
  METHODS
  From April 2013 to January 2014, we implemented 13F UMP for 22 patients with renal stones that were 2 to 3 cm with the patient positioned in a 45-degree semisupine combined lithotomy position. A retrograde 9.5/11.5F UAS was placed for maintaining low intrarenal pressure and debris drainage. Flexible ureteroscopy was used for stones inaccessible through the primary percutaneous tract in two patients. A 200-μ holmium laser was used for stone disintegration. Intrapelvic pressure was measured using an open end 5F ureteral catheter inserted through the UAS.
  
  
  RESULTS
  All 22 cases were completed successfully. The mean preoperative stone size was 26.6 ± 4.7 mm (range 21-32 mm), mean operative time was 85.7 ± 18.0 minutes (range 47-112 min), and mean hemoglobin drop was 1.2 ± 0.3 g/dL (range 0.5-2.2 g/dL). Intrapelvic pressure during the surgical procedure ranged 5 to 10 cm H2O. The mean hospital stay was 3.1 ± 1.8 days (range 2-5 d). Complete stone clearance was 18/22 (81.8%) with solo UMP and 20/22 (90.9%) when associated with retrograde intrarenal surgery (RIRS). No major intra- or postoperative complications occurred.
  
  
  CONCLUSIONS
  Implementation of UMP for the treatment of patients with renal stones 2-3 cm is feasible and safe. The procedure is less invasive and has a faster recovery period. Intraoperative retrograde UAS decreases intrarenal pressure, facilitates removal of stone fragments, and also allows simultaneous RIRS for stones in an inaccessible calix.
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Shah
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Liangkuan
authors.initials: L
authors.lastname: Bi
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Han
authors.initials: H
authors.lastname: Jinli
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Xinxiang
authors.initials: X
authors.lastname: Fan
authors.affiliation: 2 Sun Yat-sen University , North Campus, Guangzhou, China .
authors.forename: Rujan
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: 1 Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China .
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D053844:Lasers, Solid-State / Q000627:therapeutic use; D007902:Length of Stay; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D055815:Young Adult