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Randomized control trial to compare mini-PCNL vs standard-PCNL for treatment of 1-2 cm size inferior calyceal renal
Puneet Aggarwal1, Sanjeev Tandon2
1Senior Advisor (Surgery) & Urologist, Army Hospital (R & R), Delhi Cantt, India.
Background:
Lower calyceal anatomy makes the stone clearance a difficult task across all treatment formats. Improvement in optics and miniaturization of instruments have offered an effective and safer alternative to percutaneous nephrolithotomy (PCNL). The study was conducted to compare the efficacy and complications associated with mini-PCNL vs standard-PCNL.
Methods:
The study was a randomized control trial to compare mini-PCNL vs standard-PCNL for treatment of 1 to 2 cm inferior calyceal stones. Objectives were to compare peri-operative bleeding, operative-time, post-op analgesia requirement, hospital-stay and stone-free rate at 1 month. Patients with 1-2 cm inferior calyceal stones were included. Morbidly obese individuals, patients with renal malformation and paediatric age group were excluded.
Result:
One hundred and fifty seven patients were included out of 207 who underwent PCNL in this period. 80 underwent mini-PCNL and 77 standard-PCNL. Mini-PCNL scored over standard in hospital-stay (3.96 vs 4.73 days), post-operative analgesia requirement (2.58 vs 5.55 gms) and drop in Hb (0.59 vs 0.81 gm/dl). Even stone clearance rate was better for mini-PCNL (87.01% vs 93.75%). Mean surgery time was marginally better for standard-PCNL (44.03 vs 43.33 mins). Stone clearance rate and average surgery time were comparable with no statistically significant difference in the two groups. Analgesia requirement was statistically lower in mini-PCNL due to smaller tract and tubeless-PCNL. Hospital stay was statistically lower in mini-PCNL due to lesser post-operative pain. Peri-operative bleeding was statistically lower in mini-PCNL due to smaller track dilatation and lesser tract bleeding.
Conclusions:
Mini-PCNL is a safe and effective treatment option in the management of 1-2 cm inferior calyceal stones with significantly less bleeding, shorter hospital-stay and analgesia requirement as compared to standard-PCNL with comparable stone clearance rates.
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