[Minimally invasive percutaneous nephrolitholapaxy (MIP)].

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Treatment

Background:

• Conventional percutaneous nephrolithopaxy (PCNL) offers high stone-free rates but involves significant morbidity.
• Miniaturized PCNL (Mini-Perc) reduces morbidity but may compromise stone clearance.
• There is a need for kidney stone treatment combining efficacy, low morbidity, and patient comfort.

Purpose of the Study:

• To introduce and evaluate Minimally Invasive Percutaneous Nephrolithopaxy (MIP).
• To assess the efficacy, safety, and patient comfort of MIP.
• To establish MIP as an evolution of Mini-Perc in modern stone therapy.

Main Methods:

• MIP utilizes an 18-Fr Amplatz sheath, ultrasound-guided renal access, and single-step tract dilatation.
• The procedure incorporates ballistic lithotripsy and a low-pressure irrigation system with a "vacuum cleaner effect" for fragment removal.
• A sealed, tubeless access tract with primary closure is employed, independent of hemorrhage and without second-look procedures.

Main Results:

• Achieved a primary stone-free rate of 92.9% in the first 57 patients.
• Average operating time was 62 minutes, with no severe complications like sepsis or bleeding requiring transfusion.
• Low morbidity comparable to ureteroscopy and extracorporeal shock-wave lithotripsy was observed, with a reintervention rate under 8%.

Conclusions:

• MIP combines high stone-free rates with low morbidity and enhanced patient comfort.
• The "vacuum cleaner effect" and tubeless closure contribute to reduced operating time and improved patient experience.
• MIP represents a promising advancement in kidney stone management, evolving from Mini-Perc techniques.