A Modified Mini Percutaneous Nephrolithotomy (m2PCNL) for Staghorn Calculi

A Modified Mini Percutaneous Nephrolithotomy (m2PCNL) for Staghorn Calculi
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Title:A Modified Mini Percutaneous Nephrolithotomy (m2PCNL) for Staghorn Calculi
Author/Abstract:

Michael Alfred V. Tan, MD and Dennis G. Lusaya, MD, FPUA
Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Objectives: Modifications in endourologic methods of stone removal are aimed at increasing stone
clearance while minimizing complications and morbidity. Our study seeks to evaluate the efficacy,
safety, and morbidity of a modified mini-percutaneous nephrolithotomy (m2PCNL) in patients with
staghorn calculi.

Materials and Methods: A modified mini PCNL procedure was done using a 19F nephroscope without
a secondary sheath, through a 22F Amplatz Teflon access sheath. Standard PCNL equipment were
used for stone fragmentation and evacuation. A DJ stent was placed in an antegrade manner, after
which a nephrostomy tube was also placed. Outcomes of m2PCNL done in our first 28 patients with
staghorn caculi were reviewed for this study.

Results: Our results showed a (27/28) 96.4% primary stone-free rate with m2PCNL for stones > 4cm2
in surface area. Patients were followed up at 3 and 6 months post operatively and were still stone free.
Average operative time was 55 minutes, average blood loss was 50 cc and average hospital stay was
3.5 days. Two patients had urinary tract infection, while one patient had sepsis post operatively. No
other morbidities were noted.

Conclusion: Modified mini PCNL has a well-defined role in many patients. It is a safe procedure with
a high stone-free rate and with minimal associated morbidity. We recommend m2PCNL for patients
with moderate to large stone burdens (4-6 cm2 cross sectional area) and for patients with calculi in a
calyceal diverticulum. From our experience, patients with larger stone burdens (even stones with >6
cm2 in cross-sectional area) can also be considered candidates for m2PCNL.

Key words: percutaneous nephrolithotomy, stagorn calculi

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