Modified minimal invasive stone treatment : tubeless mini PCNL in supine position

Abstract EN

The objective of the study was to show the feasibility and efficiency of a mini PCNL in a modified supine (Valdivia) position, as well as sealing the nephrostomy channel using a haemostyptic (gelatine matrix with thrombin) in a random comparative study.

Between 6/2014 and 10/2015, 57 prospective randomised patients were analysed.

All patients presenting with stones up to 4 cm were included in the analysis.

The procedures were performed in the Valdivia position, using a mini nephroscope with 18 Charr Amplatz shaft.

At the end of surgery the nephrostomy channel was sealed and secured using a haemostyptic (tubeless group, n=30).

In the control group (n=27), the mini PCNL was performed using the abdominal approach and nephrostomy closing procedure.

The surgery time, duration of the ureter stents, post-operative analgesic requirements, haemoglobin clearance, stone free rates and complications were recorded according tq the Clavien-Dindo classification tables.

The surgery time (78 vs 90 min), duration of ureter stent retention (3,2 vs 4,0 d), duration of hospital stay (4,8 vs 6,2 d), haemoglobin clearance (0,61 vs 0,63 mmol/l), macro-haematuria (1,6 vs 2,3 d), analgesic requirements (2,1 vs 2,6 times post-operative Novalgin), stone free (90 vs 81,5%) and complications (3 vs 7) were reduced in the tubeless group.

The initial data relating to the tubeless mini PCNL in a Valdivia position shows that this modification may be implemented without an increase in complications.

The total treatment process is, from all patient perspectives, easier and faster.

However, the results shown must be verified in a larger cohort to confirm reliability