title: Extending indications of micropercutaneous nephrolithotomy: It is not just about cracking stones.
abstract: OBJECTIVE
  To describe our experience and results of using the MicroPerc™ micropercutaneous nephrolithotomy armamentarium (PolyDiagnost, Germany) for unusual indications unexplored using this modality.
  
  
  METHODS
  We used the MicroPerc™ system for stone clearance in three ureteric calculi, two bladder calculi, one case of urethral calculus, for antegrade biopsy in a case of upper tract urothelial carcinoma, for Deflux® (dextranomer/hyaluronic copolymer, Salix Pharmaceuticals, Uppsala, Sweden) injection in three cases of vesico-ureteric reflux (VUR), and three cases of posterior urethral valve (PUV) fulgurations. A 4.85-F 'All-Seeing Needle®' (PolyDiagnost) was used in most of the cases. An 8-F mini-micro sheath was used where stability was deemed necessary. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications, and outcomes were assessed.
  
  
  RESULTS
  All patients were successfully treated with complete stone clearance at 1 month with no residual fragments. The antegrade biopsy confirmed a high-grade papillary neoplasm. There were no technical difficulties with injection of Deflux or PUV fulgurations. Follow-up at 1 year revealed no stone recurrence, resolved reflux in all three cases, and all the children that had had PUVs were voiding well. The small sample and retrospective nature of the analysis are the limitations of this study.
  
  
  CONCLUSIONS
  MicroPerc™, besides its usual use for minimally invasive percutaneous nephrolithotomy, can also be feasibly used for ureteric, bladder and urethral stones, and for treating non-calculus diseases such as PUVs and VUR. True to its name, it may be an 'All-Seeing Needle' in reality with much more to offer and harvest from.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Arvind P
authors.initials: AP
authors.lastname: Ganpule
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Jaspreet Singh
authors.initials: JS
authors.lastname: Chhabra
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Sudharsan
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Ankush
authors.initials: A
authors.lastname: Jairath
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Mohankumar
authors.initials: M
authors.lastname: Vijaykumar
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Sabnis
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Mahesh R
authors.initials: MR
authors.lastname: Desai
keywords: Calculi; KUB, plain abdominal radiograph of the kidneys, ureters and bladder; MP, micropercutaneous nephrolithotomy/MicroPerc; Micropercutaneous nephrolithotomy (microperc); PCNL, percutaneous nephrolithotomy; PUV, posterior urethral valve; Posterior urethral valve (PUV); URS, ureterorenoscopy; VCUG, voiding cystourethrography; VUR; YAG, yttrium-aluminium-garnet