Category: Clinical Stones: PCNL

MP7-1 - Minimally-invasive Percutaneous Nephrolithotomy versus Conventional Percutaneous Nephrolithotomy for treatment of Large sized (20-30 mm) renal calculi- A prospective study

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : Percutaneous nephrolithotomy (PCNL) has seen changes in recent years in an attempt to improve efficacy and reduce morbidity. Newer modalities like mini-PCNL have evolved minimising tract size, achieving similar results as conventional   PCNL with lower morbidity. However, Mini PCNL has been largely used only for small renal calculi. We conducted a study to study the results of Mini-PCNL in large volume renal stones and compare with conventional   PCNL.


Methods : we did a prospective study involving 40 adult patients with renal calculi of 20-30 mm size from January 2017 to December 2017. The patients were selected based on the size and complexity of stone and randomised into two equal groups of twenty each: group A- minimally-invasive PCNL (MIP), and group B- conventional   PCNL. We excluded any staghorn/partial staghorn cases from the study.  MIP-M nephroscope (12 F, Karl Storz, Germany) was used for MIP in group A, whereas conventional   nephroscope (20.8 F, Richard Wolf, Germany) was used for PCNL in group B. Holmium laser (Lumenis, USA) was used for fragmentation in Mini-PCNL cases whereas pneumatic lithotripsy was used in conventional   PCNL. Stone clearance was assessed by post-operative CT scan at one month in all cases.


Results : The mean age and male-female ratio was comparable in both groups. Rest of the parameters compared are listed in Table 1.  In MIP group, no nephrostomy tubes were used, whereas DJ stenting was required in 5 cases. In conventional PCNL group, 12 patients had an indwelling DJ stent whereas a nephrostomy was placed in 8 cases. The operating time was longer but hospitalization time was shorter in mini-PCNL group. The stone clearance in MIP group was 100% whereas in conventional PCNL group was 95%. Two patients required re-look in conventional PCNL group. Postoperatively, two patients in each group reported mild fever which was managed conservatively. Two cases reported PCNL site discharge in conventional PCNL group.


Conclusions :

Mini-PCNL is a viable option for large sized renal calculi with stone clearance rates comparable to conventional PCNL, in addition to lower morbidity and less need for secondary procedures. The complication rates of PCNL have decreased owing to the smaller tract size and tubeless technique.

Madhu Sudan Agrawal

Professor and Head
Department of Urology, Global Rainbow Healthcare, Agra, India
AGRA, Uttar Pradesh, India

DR (Prof) Madhu Sudan Agrawal
DOB: 21st Nov 1956
Email address: dr.madhu.agra@gmail.com
Website: www.drmadhuagrawal.com
DESIGNATION:
Head, Department of Urology & Centre for Minimally-invasive Endourology,
Global Rainbow Healthcare, Agra, India
Formerly Professor, S N Medical College, Agra, India
QUALIFICATIONS:
M.B.B.S. 1979 MLB Medical College, Jhansi
M.S. (SURGERY) 1983 AIIMS, New Delhi
M.Ch. (UROLOGY) 1989 SMS Medical College, Jaipur
HIGHLIGHTS:
• More than 100 publications in National & International Journals. Written several chapters for national and international text books.
• Presented > 200 papers, delivered > 200 guest lectures, in National & International Conferences.
• Received multiple Best paper and poster awards in National & International conferences, including ‘Best Paper’ award at the World Congress of Endourology, 2014.
• Reviewer for multiple National & International Journals, including: AUA, BJUI, J Endourology, Indian J Urology, Indian J Surgery, Indian J Med Res, etc.
• One of the pioneers in Endourology in India since 1980’s, popularized several new techniques including Tubeless PCNL, Ultrasound-guided puncture, MIP (Minimally-invasive PCNL) with Laser.
• Organized zonal and national annual conferences of Urological Society of India as Organizing Secretary and Organizing Chairman at Agra (years 2010 and 2016).
• Conducting national and international live operative workshops and training programs in Endourology at Global Rainbow Healthcare on a regular basis.
• Held various positions in Urological Society of India, including Council member, Convener of Services cell, Convener of Endourology Section, Honorary Treasurer of USI, President of North Zone chapter of USI.
• Recipient of PV Rao Oration 2006, PN Kataria Oration 2010, Marudhara Jodhpur Urology Oration 2013, President’s Gold Medal 2016, Ranganadha Rao Oration of SOGUS 2017, of Urological Society of India.
• Delivered Urological Association of Asia (UAA) Lecture at the European Urological Association (EAU) Annual Meeting 2017 in London.
• Presently President-Elect of Urological Society of India (2018-19).

Dilip Kumar Mishra

Consultant Urologist
Department of Urology, Global Rainbow Healthcare, Agra, India
Agra, Uttar Pradesh, India