Introduction: Perspectives and possibilities of urolithiasis surgical treatment have greatly increased during the last years.
Aim: A comparative evaluation of efficacy of standard percutaneous nephrolithotripsy and mini-nephrolitholapaxy in patients with large (up to 2,5 - 3 cm) renal and ureteral stones.
Materials and methods: In urology clinic of National Medical and Surgical Center named after N.I. Pirogov 215 patients were treated for nephrolithiasis between May 2015 and December 2017. Standard (SNL) nephrolithotripsy and extraction (nephrolitholapaxy) requiring a 30 Ch access was performed in 112, who comprised group 1. Percutaneous mini-nephrolitholapaxy (MNL) through 15 (16,5) Ch was performed in 103 patients (group 2).
Results: Stone size in two groups was within set limits, with 43% of stones being smaller and 57% stones being larger than 12 cm3. Solitary stones were found in 82% (85 in group 1, 91 in group 2) patients, staghorn calculi were found in 18% (in 27 and 12 respectively) patients. In 28%, 57%, 9% patients stones were located in calyces, pelvis and ureteropelvic junction respectively, without significant differences between groups. Signs of obstruction and impairment of intrarenal urodynamics were found in 32% patients with similar distribution in groups 1 and 2. Mean operative time was 110 (65 – 240) minutes, in group 1 – 98 minutes, in group 2 – 134 minutes.
Duration of x-ray screening was 12 (5 - 37) minutes (15 in group 1, 9 in group 2). Complications caused by surgical intervention were represented by bleeding (14%) and upper urinary tract perforation (7%).
Blood transfusion was required in 2 patients from standard group. Emergent urinary infection required adjustment of antibacterial therapy in 11% of patients.
Stone free rate after surgery was 67% (61% in group 1, 88% in group 2), and 1 month after the surgery it was 89% (82% and 96% respectively). According to nuclear renal scan, recovery of renal function doesn’t depend on access width. Focal damage to parenchyma was found in 36% of patients who underwent standard treatment.
Conclusion: Percutaneous mini-nephrolitholapaxy today is a highly efficacious and minimally invasive technique which allows to get rid even of staghorn nephrolithiasis, to decrease possible intraoperative and postoperative risks and to return the patient to fully active state within the shortest time.
Authors declare lack of the possible conflicts of interests