Ultra-mini flexible percutaneous nephrolithotomy in the treatment of moderate-size kidney stones: a new instrument, a pr
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ORIGINAL PAPER
Ultra‑mini flexible percutaneous nephrolithotomy in the treatment of moderate‑size kidney stones: a new instrument, a preliminary prospective study Fatih Kursat Yilmazel1 · Ahmet Emre Cinislioglu1 · Ibrahim Karabulut1 · Ali Haydar Yilmaz2 · Fatih Ozkaya3 · Senol Adanur3 Received: 15 July 2020 / Accepted: 23 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Ultra-mini PNL is increasingly preferred in the treatment of kidney stones. Unlike routine applications of the ultra-mini PNL technique, we aimed to perform kidney stones treatment with an epiduroscopic device that can pass through 11–13Fr ureteral access sheaths with a flexible structure and which is routine in neurosurgical practice. The study was planned prospectively. The study included 52 patients with mid-sized kidney stones who had presented to our clinic between July 2017 and January 2019. The ultra-mini percutaneous nephrolithotomy was carried out with epiduroscopy routinely used in neurosurgery practice, which can pass through 11–13-Fr ureteral access and has a flexible structure. The perioperative and postoperative parameters were analyzed. The mean operation time was 45.6 ± 4.8 min and entry was provided through a single entry (from the calyx appropriate to the lower pole) in all patients; a second entry tract was not required. No DJ catheter or nephrostomy tube was installed in any patient and the procedures were completed totally without a tube. The mean reduction in hemoglobin values was determined as 0.33 (0.1–1.1) g/dL. None of the patients needed transfusion and no patient developed acute kidney injury. Clinically significant (≥ 3 mm) residual stone was observed in 2 (4%) of the 52 patients, while clinically insignificant (≤ 3 mm) stones were observed in 50 patients (96%). The mean length of hospital stay was 2.5 ± 0.9 days. Ultra-mini flexible percutaneous nephrolithotomy is an effective and safe method in the treatment of medium-sized kidney stones. Keywords Renal stones · Percutaneous nephrolithotomy · Ultra-mini flexible percutaneous nephrolithotomy
Introduction and objective Percutaneous nephrolithotomy (PNL) was first described by Fernström and Johansson in 1976 in the treatment of kidney stones [1]. Compared to open surgery, PNL has become the preferred method in time due to its high success rate, short recovery and hospital stay, in addition to
its cosmetic superiority [2, 3]. The high stone-free rates of PNL constitute its most important advantage compared to minimally invasive procedures such as retrograde intrarenal surgery (RIRS) and shock-wave lithotripsy (SWL). The most important drawback for this effective surgical procedure is the bleeding complication (11.2–17.5%), which is rather
* Ahmet Emre Cinislioglu [email protected]
Senol Adanur [email protected]
Fatih Kursat Yilmazel [email protected]
1
Ibrahim Karabulut [email protected]
Department of Urology, University of Health Sciences Turkey, Erzurum Regional Training and Research Hosp
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