Category: Clinical Stones: PCNL

MP7-15 - The introduction of super-mini percutaneous nephrolithotomy in a UK stone unit

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

Introduction & Objective :

The miniaturisation of percutaneous nephrolithotomy (PCNL) is an increasingly popular concept, intended to reduce post-operative pain and enhance recovery. Super-mini PCNL (SMP) is a novel method that differs from other miniaturisation techniques by offering active and passive suction through the unique 14Fr sheath while laser lithotripsy is performed. The objective of this study was to assess surgical outcomes and patient experience.


Methods :

Patients with renal stones not suitable for ESWL or retrograde intrarenal surgery (RIRS) underwent SMP and data was collected prospectively. Only patients who had completed a minimum of 3 months follow up were included.
Stone parameters (size, Hounsfield unit and complexity according to Guy’s stone score) were evaluated before the procedure. Peri-operative outcomes (operative time, Haemoglobin drop, transfusion rate, pain score - Pain assessment Scale), complications, length of stay and stone-free status were evaluated. Quality of life assessments using the EQ-5D-5L Value Set were also made before and 6 weeks after surgery.
Ultrasound was performed 6-8 weeks post-operatively to determine stone-free status.
The statistical analysis using SPSS 2.0 software was performed.


Results :

A total of 28 patients underwent SMP from January 2016 to January 2018.
Eighty nine percent of patients (89.2%, 25/28) were totally tubeless. Eleven percent of patients (10.7%, 3/28) had tubes sited; 2 had nephrostomy tubes for known PUJ obstruction, and one who underwent a multi-track SMP had an antegrade stent insertion, due to a high risk of sepsis from recent sepsis and infected stones.
Fifty three percent of patients (53.6 %, 15/28) had < 24 hours admission and the mean hospital stay was 1.2 days.  The mean Hb drop was 1.36 g/dL and no patients required a blood transfusion.
Stone free rate at 3 months was 96.5% (27/28).
There was a significant improvement in the mean pain score from (3.25 pre-operatively to 1.25 post-operatively (p=0.0499). Similarly, QoL scores improved from 75 to 87.25 (p=0.0148).


Conclusions :

Our early results of SMP demonstrate that this technique is safe and effective in the treatment of stones <20mm. It is associated with low levels of blood loss, short operative time, high rate tubeless procedures, short length of stay and improved patient quality of life.

Giuseppe Celentano

Clinical Fellow
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Michael Mikhail

Trainee
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Vimoshan Arumuham

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Ali Tasleem

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Simon Choong

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Clare Allen

Navin Ramachandran