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Role of minimally invasive (Micro and Ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review

Role of minimally invasive (Micro and Ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review
Role of minimally invasive (Micro and Ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review

PURPOSE OF REVIEW: The role of PCNL and the expertise surrounding it has expanded in recent decades. Miniaturisation of equipment and instrument size has formed a part of this innovation. Although an increasing number of studies have been performed on miniaturised PCNL (Mi-PCNL) recently, a critical appraisal on these is lacking. We therefore conducted a systematic review of the literature to evaluate the efficacy, safety and feasibility of Mi-PCNL techniques (< 15 Fr).

RECENT FINDINGS: A systematic review was conducted from 1990 to March 2017 on outcomes of Mi-PCNL [micro PCNL (m-PCNL) and ultra-mini PCNL (UMP)] in adult patients. Ten studies (three on m-PCNL and seven on UMP) were included in our study. Across the three studies, 118 patients (mean age 42.2 years, male to female ratio 1.3:1) underwent m-PCNL (4.8 Fr). For a mean stone size of 13.9 mm, a mean stone-free rate (SFR) was 89% and an overall complication rate was 15.2% [Clavien classification I (44%), II (28%), III (28%)], with no Clavien IV or V complications. Across the seven studies, 262 patients (mean age 49.4 years, male to female ratio 1.5:1) underwent UMP (13-14 Fr). For a mean stone size of 18.6 mm, a mean SFR was 88.3% and an overall complication rate was 6.2% [Clavien classification I (57%), II (36%), III (7%)], with no Clavien IV or V complications. While the transfusion rates for m-PCNL was 0.85%, only one case each in m-PCNL and UMP needed conversion to mini PCNL. Our review shows that for small- to medium-sized renal stones, Mi-PCNL can yield good stone-free rates whilst maintaining a low morbidity associated with it. There were no Clavien > III complications and no mortality with only one transfusion reported from this minimally invasive technique.

Journal Article, Review
1534-6285
1-8
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Elmussareh, Muhammad
d7a436f2-07a3-4d69-9ee1-8f384a0b42d0
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Mucksavage, Phillip
68dc838f-ebcb-4143-bd4b-b5389150f11d
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Elmussareh, Muhammad
d7a436f2-07a3-4d69-9ee1-8f384a0b42d0
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Mucksavage, Phillip
68dc838f-ebcb-4143-bd4b-b5389150f11d
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Jones, Patrick, Elmussareh, Muhammad, Aboumarzouk, Omar M, Mucksavage, Phillip and Somani, Bhaskar K (2018) Role of minimally invasive (Micro and Ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review. Current Urology Reports, 19 (4), 1-8, [27]. (doi:10.1007/s11934-018-0764-5).

Record type: Review

Abstract

PURPOSE OF REVIEW: The role of PCNL and the expertise surrounding it has expanded in recent decades. Miniaturisation of equipment and instrument size has formed a part of this innovation. Although an increasing number of studies have been performed on miniaturised PCNL (Mi-PCNL) recently, a critical appraisal on these is lacking. We therefore conducted a systematic review of the literature to evaluate the efficacy, safety and feasibility of Mi-PCNL techniques (< 15 Fr).

RECENT FINDINGS: A systematic review was conducted from 1990 to March 2017 on outcomes of Mi-PCNL [micro PCNL (m-PCNL) and ultra-mini PCNL (UMP)] in adult patients. Ten studies (three on m-PCNL and seven on UMP) were included in our study. Across the three studies, 118 patients (mean age 42.2 years, male to female ratio 1.3:1) underwent m-PCNL (4.8 Fr). For a mean stone size of 13.9 mm, a mean stone-free rate (SFR) was 89% and an overall complication rate was 15.2% [Clavien classification I (44%), II (28%), III (28%)], with no Clavien IV or V complications. Across the seven studies, 262 patients (mean age 49.4 years, male to female ratio 1.5:1) underwent UMP (13-14 Fr). For a mean stone size of 18.6 mm, a mean SFR was 88.3% and an overall complication rate was 6.2% [Clavien classification I (57%), II (36%), III (7%)], with no Clavien IV or V complications. While the transfusion rates for m-PCNL was 0.85%, only one case each in m-PCNL and UMP needed conversion to mini PCNL. Our review shows that for small- to medium-sized renal stones, Mi-PCNL can yield good stone-free rates whilst maintaining a low morbidity associated with it. There were no Clavien > III complications and no mortality with only one transfusion reported from this minimally invasive technique.

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More information

Accepted/In Press date: 1 April 2016
e-pub ahead of print date: 7 March 2018
Published date: April 2018
Keywords: Journal Article, Review

Identifiers

Local EPrints ID: 418998
URI: http://eprints.soton.ac.uk/id/eprint/418998
ISSN: 1534-6285
PURE UUID: 5b0c22d4-45f9-4fb1-9a5c-7ab0d74e7e1d

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Date deposited: 27 Mar 2018 16:30
Last modified: 20 Mar 2020 17:30

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Contributors

Author: Patrick Jones
Author: Muhammad Elmussareh
Author: Omar M Aboumarzouk
Author: Phillip Mucksavage

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