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Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath
Jiqing Zhang1, Ning Kang1, Yuguang Jiang1
1Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Background:
Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS).
Methods:
Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position.
Results:
Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively.
Conclusions:
Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.
Insights
This study shows that a self-assembled visual needle and ureteral access sheath (UAS) is effective for micropercutaneous nephrolithotomy (microperc). The technique achieved a 100% stone-free rate by three months, demonstrating its potential to improve outcomes in kidney stone treatment.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Background:
- Micropercutaneous nephrolithotomy (microperc) is a minimally invasive procedure for kidney stones.
- While effective, modifications to microperc techniques can enhance outcomes.
- This study explores a novel self-assembled visual needle and ureteral access sheath (UAS) for microperc.
Purpose of the Study:
- To evaluate the efficacy and safety of a self-assembled visual needle and UAS for microperc procedures.
- To assess the stone-free rates and clinical outcomes associated with this modified technique.
Main Methods:
- Retrospective analysis of 30 patients undergoing microperc with a self-assembled 4.8 Fr visual needle and UAS.
- Patients were positioned in an oblique lithotomy position.
- Data collected included operative time, pain scores, hemoglobin decrease, hospital stay, and stone-free rates.
Main Results:
- 28 cases were analyzed after exclusions.
- The mean operative time was 47 minutes, with low postoperative pain (VAS 2.5) and minimal hemoglobin decrease (6.4 g/L).
- Stone-free rates were 42.9% at day 1, 92.9% at month 1, and 100% at month 3. Complications were minor and resolved with treatment.
Conclusions:
- The self-assembled visual needle and UAS is an effective instrument for microperc.
- The use of a UAS in conjunction with microperc may improve operative outcomes and achieve high stone-free rates.
