Nikoufar Parsa, Hodhod Amr, Hadi Ruba Abdul, Abbas Loay, Vangala Sai K, Zakaria Ahmed S, Gawish Maher, Alaref Amer, Rozenberg Radu, Elmansy Hazem
Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
Department of Urology, King Abdulaziz Medical City, National Guard Hospitals Affairs, Riyadh, Saudi Arabia.
Can Urol Assoc J. 2024 Oct;18(10):341-347. doi: 10.5489/cuaj.8764.
This study aimed to assess the safety and efficacy of ambulatory minipercutaneous nephrolithotomy (mini-PCNL) in a totally tubeless exit (without a nephrostomy tube or an internal stent) and tubeless exit (without a nephrostomy tube but with an internal stent) for the treatment of renal calculi 10-25 mm in size.
We conducted a retrospective analysis of patients who underwent mini-PCNL at our institution between September 2018 and September 2022. The study included a cohort of 95 patients diagnosed with renal calculi measuring 10-25 mm. All patients underwent a computed tomography (CT) renal colic scan preoperatively, on postoperative day one (POD 1), and at three-month followup. Patient demographics and outcome parameters were recorded, including stone characteristics, operative time, hospital stay, stone-free rate (SFR), complication rates, and subsequent emergency room (ER) visits. Patients were considered stone-free if they had no fragments or residual fragments measuring <4 mm.
The median maximum stone diameter was 16 mm (10-25 mm). Twenty-nine patients (30.5%) had multiple renal calculi. The median operative time was 64 (38-135) minutes. Eighty-six patients (90.5%) underwent a totally tubeless procedure, without a nephrostomy tube or an internal stent. All patients were discharged home on the same operative day with a median hospitalization time of six hours. Seven (7.4%) postoperative ER visits were recorded, and two (2.1%) led to hospital readmission. The frequency of grade I, II, and III Clavien-Dindo complications were 18 (18.9%), one (1.1%), and one (1.1%), respectively. The SFR on POD 1 and three-month followup was 73.7% and 92.6%, respectively. Two patients in the study required retreatment.
Ambulatory tubeless mini-PCNL is a safe and effective treatment option for 10-25 mm renal stones. Experienced institutions can safely adopt ambulatory mini-PCNL as a treatment option without an increased risk of postoperative complications, ER visits, or hospital readmissions.
本研究旨在评估门诊微创经皮肾镜取石术（mini-PCNL）在完全无管出院（无肾造瘘管或内支架）和无管出院（无肾造瘘管但有内支架）治疗10 - 25毫米肾结石中的安全性和有效性。
我们对2018年9月至2022年9月在我院接受mini-PCNL的患者进行了回顾性分析。该研究纳入了95例诊断为10 - 25毫米肾结石的患者队列。所有患者在术前、术后第1天（POD 1）和3个月随访时均接受了计算机断层扫描（CT）肾绞痛扫描。记录患者的人口统计学和结局参数，包括结石特征、手术时间、住院时间、无石率（SFR）、并发症发生率以及随后的急诊室（ER）就诊情况。如果患者没有<4毫米的碎片或残留碎片，则认为其无结石。
结石最大直径的中位数为16毫米（10 - 25毫米）。29例患者（30.5%）有多发性肾结石。手术时间中位数为64（38 - 135）分钟。86例患者（90.5%）接受了完全无管手术，无肾造瘘管或内支架。所有患者均在手术当天出院，住院时间中位数为6小时。记录到7例（7.4%）术后急诊室就诊，其中2例（2.1%）导致再次入院。I级、II级和III级Clavien-Dindo并发症的发生率分别为18例（18.9%）、1例（1.1%）和1例（1.1%）。POD 1和3个月随访时的无石率分别为73.7%和92.6%。该研究中有2例患者需要再次治疗。
门诊无管mini-PCNL是治疗10 - 25毫米肾结石的一种安全有效的治疗选择。经验丰富的机构可以安全地采用门诊mini-PCNL作为一种治疗选择，而不会增加术后并发症、急诊室就诊或再次入院的风险。
