title: Use of a Novel Flexible Mini-nephroscope in Minimally Invasive Percutaneous Nephrolithotomy.
abstract: OBJECTIVE
  To assess the feasibility and safety of a novel flexible mini-nephroscope in minimally invasive percutaneous nephrolithotomy (PCNL). Presumably, limiting the size and number of tracts during PCNL has the potential of decreasing the morbidity of the procedure. We present our experience with this new technique.
  
  
  METHODS
  A retrospective analysis of patients with multiple kidney stones treated with mini-PCNL combined with a novel flexible mini-nephroscope was performed. Minimally invasive PCNL was done with rigid 12 F MIP-M nephroscope, followed by flexible mini-nephroscopy for smaller stones in other inaccessible calyces. Record was made of the operating time, stone-free rates, postoperative pain, morbidity, hospital stay, time to recovery, complication rates, and ancillary procedures. Matched-pair analysis was done with cases operated by flexible ureteroscopy performed with Flex X-2 or Flex X-c scope.
  
  
  RESULTS
  Twenty-five patients in the study group were matched with 25 cases from the flexible ureteroscopy group. Both groups were comparable in terms of age, laterality, and mean composite stone burden. The mean operating time was 40.1 ± 10.6 minutes in the mini-PCNL group and 51.2 ± 8.8 minutes in the flexible ureteroscopy group. Mean hospital stay was similar in both groups. The primary stone clearance rate of 92% (23 of 25) in the mini-PCNL group was better than the clearance rate of 80% (20 of 25) in the flexible ureteroscopy group. Eight percent in the mini-PCNL group required ancillary procedures as compared with 20% of cases in the flexible ureteroscopy group. Postoperative pain and analgesia requirement in these patients was minimal. There were no significant complications.
  
  
  CONCLUSIONS
  Flexible mini-nephroscope is an effective adjuvant to minimally invasive PCNL in achieving high clearance rate with minimum morbidity.
authors.affiliation: Department of Urology, Global Rainbow Healthcare, Agra, India. Electronic address: docdilipmishra@yahoo.co.in.
authors.forename: Dilip Kumar
authors.initials: DK
authors.lastname: Mishra
authors.affiliation: Department of Urology, Global Rainbow Healthcare, Agra, India.
authors.forename: Madhu Sudan
authors.initials: MS
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D007669:Kidney Calculi / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation*; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020709:Ureteroscopes