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Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal
Mohamed F Abdelhafez1,2, Gunnar Wendt-Nordahl3, Stefan Kruck1
1a Department of Urology , University Hospital Tübingen , Tübingen , Germany ;
Objective:
The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MIP) and conventional percutaneous nephrolithotomy (PCNL) in the treatment of patients with large renal stone burden. MIP has proven its efficacy and safety in the management of small renal calculi. However, conventional PCNL is still considered the standard method for treatment of large renal stones in the upper urinary tract.
Materials And Methods:
A search of two longitudinal databases in two tertiary referral centres for complex stone disease identified 133 consecutive patients who were treated by either MIP or PCNL for renal stones 20 mm or larger between January 2009 and August 2012. Clinical data and outcome measures of the two methods were compared by Student's t test, chi-squared test or Fisher's exact test. A p value less than 0.05 was considered statistically significant.
Results:
Operative time was significantly shorter and hospital stay was significantly longer in conventional PCNL compared to MIP (p = 0.002 and < 0.001, respectively). There were no significant differences in primary stone-free rate or complication rate between the two methods. Only higher graded complications (above Clavien grade II) were significantly more common in conventional PCNL (p = 0.02).
Conclusion:
MIP is equally effective as conventional PCNL in the treatment of large renal calculi. Both methods have a similar complication rate. The shorter operative time in PCNL may be based on the larger diameter and quicker retrieval of large fragments; the longer mean hospital stay may be caused by the handling of the nephrostomy tube. The current data suggest that the choice of the method mainly depends on the surgeon's preference.
Insights
Minimally invasive percutaneous nephrolithotomy (MIP) and conventional percutaneous nephrolithotomy (PCNL) show similar efficacy and complication rates for large kidney stones. MIP offers comparable stone-free rates with potentially fewer severe complications than conventional PCNL.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Conventional percutaneous nephrolithotomy (PCNL) is the standard for large renal stones.
- Minimally invasive percutaneous nephrolithotomy (MIP) has shown promise for smaller stones.
- Efficacy and safety of MIP for large stones remain under investigation.
Purpose of the Study:
- To compare the efficacy and safety of MIP versus conventional PCNL for large renal calculi (≥20 mm).
- To evaluate operative time, stone-free rates, complication rates, and hospital stay for both procedures.
Main Methods:
- Retrospective analysis of 133 patients with large renal stones treated with MIP or PCNL.
- Data collected from January 2009 to August 2012 at two tertiary referral centers.
- Statistical comparison using Student's t test, chi-squared test, or Fisher's exact test (p<0.05 significant).
Main Results:
- No significant difference in primary stone-free rates or overall complication rates between MIP and PCNL.
- Conventional PCNL had a significantly shorter operative time (p=0.002).
- MIP was associated with a significantly shorter hospital stay (p<0.001) and fewer high-grade complications (Clavien grade >II, p=0.02).
Conclusions:
- MIP is an effective alternative to conventional PCNL for treating large renal stones.
- Both techniques offer comparable stone clearance and overall safety profiles.
- Surgeon preference may guide the choice between MIP and conventional PCNL, considering operative time and hospital stay differences.
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