Miniaturized percutaneous nephrostolithotomy reduces blood loss after renal stone removal
Conventional and miniaturized percutaneous nephrostolithotomy (mini-PCNL) are similarly effective in removing renal stones 1–3.5 cm, but blood loss is lower in mini-PCNL, a recent study has shown.
After a single procedure, 66 percent of the participants who underwent mini-PCNL were declared stone-free, similar to the 63 percent in the patients who received conventional PCNL. Initial stone volume was comparable between groups (p=0.14), but stone density was significantly greater in the mini-PCNL group (1,149±406 vs 877±386 HU; p=0.014).
Residual stone volume (0.64±1.6 vs s0.49±1.2 cm3; p=0.70), postoperative analgesic use (19.1±20.8 vs 21.1±15.2 morphine equivalents; p=0.70) and operative time (121±41 vs 124±36 minutes; p=0.74) were all statistically similar between the conventional and mini-PCNL groups. An equal number of patients from each group required a second procedure.
In comparison, the volume of blood loss was significantly lower in participants who underwent mini-PCNL vs conventional PCNL (0.90±1.3 vs 1.7±0.84; p=0.02). No blood transfusions were performed in either group.
“We do not believe mini-PCNL will replace conventional PCNL in removing large branched or staghorn calculi, but it is a viable alternative for removing stones up to 3.5 cm,” said researchers, as most of the clinical and efficacy endpoints were similar between the two procedures.
“This quality improvement study shows the single advantage of mini-PCNL was less blood loss,” they added
Researchers compared the outcomes of 29 patients (mean age 53.1±15.8 years; 19 male) who received mini-PCNL with that of 27 patients (mean age 55.5±15.3; 9 male) who had conventional PCNL. For inclusion, maximum stone size was 3.5 cm. All operations were performed by a single surgeon.