title: Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal.
abstract: BACKGROUND
  Percutaneous nephrolithotomy (PCNL) has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP), which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes.
  
  
  METHODS
  A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely.
  
  
  RESULTS
  Complete stone fragmentation was achieved in 114 out of 120 patients (95%) using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5%) patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120). There were no significant postoperative complications.
  
  
  CONCLUSIONS
  This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.
authors.affiliation: Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India.
authors.forename: Madhu Sudan
authors.initials: MS
authors.lastname: Agrawal
authors.affiliation: The Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom.
authors.forename: Ketan
authors.initials: K
authors.lastname: Agarwal
authors.affiliation: Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Jindal
authors.affiliation: Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Sharma
keywords: Nephrolithiasis; percutaneous nephrolithotomy; ultra-mini-percutaneous nephrolithotomy