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Does Miniaturization Actually Decrease Bleeding After Percutaneous Nephrolithotomy? A Single-Center Randomized Trial.

Abhishek Thakur1, Aditya Prakash Sharma1, Sudheer Kumar Devana1

  • 1Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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|October 12, 2020
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Summary

Miniaturized percutaneous nephrolithotomy (mPCNL) shows reduced postoperative bleeding and pain compared to standard PCNL (SPCNL). However, mPCNL does not eliminate the risk of significant bleeding requiring transfusion.

Keywords:
MiniPCNLbleedingcomplicationsminipercpercutaneous nephrolithotomyrandomized control trial

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrolithiasis Treatment

Background:

  • Miniaturized percutaneous nephrolithotomy (mPCNL) was developed to lessen postoperative bleeding by minimizing parenchymal injury compared to standard PCNL (SPCNL).
  • Existing randomized controlled trials (RCTs) on mPCNL's effectiveness in reducing bleeding have yielded conflicting results, indicating a need for more robust evidence.

Purpose of the Study:

  • To prospectively compare the outcomes of mPCNL versus SPCNL in patients with renal stones measuring 1 to 3 cm.
  • To evaluate postoperative bleeding and pain associated with mPCNL and SPCNL.

Main Methods:

  • A prospective randomized controlled trial was conducted comparing mPCNL and SPCNL for renal stones (1-3 cm).
  • Exclusion criteria included active UTI, renal malformation, uncorrected coagulopathy, and elevated creatinine (>1.5 mg/dL).
  • Postoperative bleeding was assessed by hemoglobin and hematocrit drop on day 1; pain was measured using the visual analogue scale (VAS) at 6, 24, and 48 hours.

Main Results:

  • A total of 60 patients (30 per group) were enrolled with comparable baseline characteristics.
  • The SPCNL group showed a significantly higher drop in hematocrit (4.6% vs. 3.1%, p=0.02) compared to mPCNL.
  • While hemoglobin drop was higher in SPCNL (1.61 vs. 1.21 gm%), it was not statistically significant (p=0.07).
  • VAS scores for pain were significantly lower in the mPCNL group at 6 and 24 hours (p=0.002 and p=0.001, respectively).
  • Blood transfusion rates and postoperative complications were similar between groups.

Conclusions:

  • mPCNL is associated with reduced postoperative bleeding and pain compared to SPCNL.
  • Despite the smaller tract, mPCNL does not entirely prevent clinically significant bleeding requiring blood transfusion.