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[Micropercutaneous laser nephrolithotripsy].

A G Martov1,2,3,4, S V Dutov1,2,3,4, S V Popov1,2,3,4

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Micro-Percutaneous Nephrolithotripsy (micro-PCNL) offers a safe and effective solution for kidney stones. This minimally invasive technique achieves high stone-free rates, even for larger stones, demonstrating its significant role in urological treatment.

Keywords:
all-seeing needleholmium lasermicropercutaneous nephrolithotomythulium fiber laserureteral access sheath

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Area of Science:

  • Urology
  • Minimally Invasive Surgery

Background:

  • Micro-Percutaneous Nephrolithotripsy (micro-PCNL) represents the least invasive form of PCNL.
  • It features endoscopic control of kidney puncture and a 4.85-8 F working channel.

Purpose of the Study:

  • To evaluate the efficacy and applicability of micro-PCNL in treating kidney stones.
  • To define the role of micro-PCNL in the management of nephrolithiasis.

Main Methods:

  • A study included 74 patients (mean age 49.8 years) with kidney stones, categorized by size (<1.5 cm and >1.5 cm).
  • Procedures involved ureteral access sheaths (10/12 F or 4.85 F) and holmium or thulium fiber lasers for stone disintegration.
  • Pre-stenting was performed in 54% of cases.

Main Results:

  • The overall one-session stone-free rate was 89.1%, with higher rates for smaller stones (93.4% for <1.5 cm vs. 82.4% for >1.5 cm).
  • Complications included acute pyelonephritis (8.1%) and residual stones requiring further treatment (9.4%).
  • No intraoperative bleeding occurred.

Conclusions:

  • Micro-PCNL is a highly effective and safe treatment for kidney stones.
  • Utilizing a 10/12 F ureteral access sheath and an 8 F working sheath facilitates fragment clearance, enabling successful micro-PCNL for larger stones (>1.5 cm).