Comparative Outcomes of Conventional and Miniaturized Percutaneous Nephrostolithotomy for the Treatment of Kidney Stones—Does a Miniaturized Tract Improve Quality of Care?

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Abstract

Introduction:

Percutaneous nephrostolithotomy is the method of choice to treat renal stones larger than 2 cm due to its high stone-free rates but it has potentially increased blood loss, postoperative pain and hospital stay compared to other treatments. Miniaturizing the percutaneous tract has recently gained interest. We performed a quality improvement study to investigate whether mini percutaneous nephrostolithotomy would reduce postoperative analgesic use, blood loss, operative time and/or hospital stay relative to the conventional approach while maintaining stone-free rates in our patient population.

Methods:

The outcomes of 29 consecutive mini percutaneous nephrostolithotomies were compared to 27 conventional procedures performed by a single surgeon at our institution. Inclusion criteria were age 18 years or older, body mass index 18 to 40 kg/m2 and first look percutaneous nephrostolithotomy for stones 1 to 3.5 cm. Conventional percutaneous nephrostolithotomy was performed through a 30Fr tract, whereas the mini approach was done through a 16.5Fr tract. All percutaneous access was performed by the surgeon.

Results:

A total of 17 patients in the conventional percutaneous nephrostolithotomy group and 19 in the mini approach group were stone-free after 1 procedure. There was no significant difference in residual stone burden, operative time or postoperative analgesic use between groups. There was significantly less blood loss (p = 0.02) in the mini percutaneous nephrostolithotomy group.

Conclusions:

Conventional and mini percutaneous nephrostolithotomies are effective methods of removing renal stones 1 to 3.5 cm in greatest dimension. There is no difference in residual stone volume, postoperative analgesic use or operative time between the 2 modalities, but blood loss is less in the mini percutaneous nephrostolithotomy group.

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