Presentation Authors: Wen Zhong*, Guohua Zeng, Guangzhou, China, People's Republic of
Introduction: Mini-percutaneous nephrolithotomy (mPCNL) has been a well established procedure for renal stone. However, small percutaneous tract of 18Fr was likely to prolong operation time, and bring intraoperative high renal pelvic pressureï¼ˆRPPï¼‰ and following postoperative fever. Super mini-PCNL(SMP) was established and becoming popular in recent years,even though a 14Fr tract was used,the nature of suction sheath brought excellent stone fragments and irrigation extraction, but only for stone less than 2.5cm. On the basis of SMP, the negative pressure suction sheath was enlarged to 18 Fr to improve lithotripsy efficiency and maintain low renal pelvic pressure, named enhanced super mini-PCNL (eSMP). The present study compared the intraoperative RPP and stone removal efficiency between 18Fr enhanced SMP (eSMP) and traditional mini-PCNL (mPCNL) in the treatment of renal calculi larger than 2.5cm.
Methods: 110 patients were randomly divided into eSMP group and mPCNL group. 18Fr metal suction sheath ahd peel-away sheath were used in eSMP and mPCNL group, respectively.RPP was measured with pressure transducer.
Results: There was no significant difference between the two groups in age(40.1Â±17.7 vs.44.2Â±21.1y, p=0.102), BMI(24.1Â±6.5 vs.23.5Â±7.3 kg/m2, p=0.753), stone size (4.1Â±0.7 vs. 4.3Â±0.9 cm, p=0.945). The basal RPP in eSMP and mPCNL group was 13.0Â±3.2 and 12.1Â±2.9mmHg, respectively, with no statistical difference (p=0.504), while the RPP in eSMP group was decreased(13.0Â±3.2 vs.9.5Â±3.6mmHg), the RPP in mPCNL group was increased(12.1Â±2.9 vs.16.5 Â±4.4mmHg), but there was no statistical difference (p> 0.05). RPP in eSMP group was lower than mPCNL group(9.5 Â±3.6 vs.16.5Â±4.4mmHg, p=0.023). The operation time in eSMP group was shorter than that in mPCNL group (58.6Â±21.4 vs.84.4Â±37.2minï¼Œp=0.035),and also the lithotripsy timeï¼ˆ49.1Â±17.3 vs.75.3Â±30.4minï¼Œp=0.027).There was no statistical difference in stone volume between the two groupsï¼ˆ12.8Â±5.2 vs.12.0Â±6.3mlï¼Œp=0.768ï¼‰, but the stone removal efficacy by metal negative pressure suction sheath in eSMP group was superior to peel-away sheath in mPCNL group (0.240Â±0.017 vs.0.159Â±0.022ml/min, p=0.041).There was no significant difference between the two groups in terms of postoperative hemoglobin decrease(11.6Â±5.4 vs.9.1Â±4.7g/Lï¼Œp=0.873), postoperative fever rate (2/55 vs.5/55, p=0.438ï¼‰ï¼Œpostoperative stone clearance rateï¼ˆ50/55 vs.47/55,p=0.376ï¼‰ï¼Œand hospital stay (2.9Â±0.5 vs.3.1Â±0.4dï¼Œp=0.796).
Conclusions: Enhanced-SMPï¼ˆeSMPï¼‰can accelerate lithotripsy efficiency and maintain low renal pelvic pressure compared with traditional mPCNL by suction sheath.