title: Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi.
abstract: OBJECTIVE
  We aimed to present the technique of combination of standard percutaneous nephrolithotomy (PNL) with microperc for achieving higher success rates without increasing complication rates in the management of complex renal calculi.
  
  
  METHODS
  The patients who underwent microperc procedure as a complementary procedure to standard PNL for complex kidney stones in two reference hospitals between 2013 and 2015, were evaluated retrospectively.
  
  
  RESULTS
  All patients underwent a total of two accesses one for standard PNL and one for microperc. The mean stone size was measured as 54.3 mm. The procedures were completed after an average operative time of 88.2 minutes and fluoroscopy time of 5.3 minutes. Stone free status was achieved in 18 cases (78.2%) and small residual fragments (≤4 mm) were detected in 3 cases (13.1%). Complications were seen in three patients (13%) as hemorrhage in one and postoperative fever in two patients.
  
  
  CONCLUSIONS
  Despite the limitations of this study, the combination of standard PNL and microperc might reduce the complication rates and increase the success rates when treating complex kidney stones. Future prospective and comparative studies are needed.
authors.affiliation: Department of Urology, Mevlana University School of Medicine, Konya, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Buldu
authors.affiliation: Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.affiliation: Department of Urology, Mevlana University School of Medicine, Konya, Turkey.
authors.forename: Tuna
authors.initials: T
authors.lastname: Karatağ
authors.affiliation: Department of Urology, Mevlana University School of Medicine, Konya, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: İnan
authors.affiliation: Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armağan
authors.affiliation: Department of Urology, Mevlana University School of Medicine, Konya, Turkey.
authors.forename: Okan
authors.initials: O
authors.lastname: İstanbulluoğlu
keywords: Complex kidney stone; microperc; outcome; standard percutaneous nephrolithotomy