EAU 2017: A Comparison Among Pcnl, Miniperc And Ultraminiperc For Lower Calyceal Stones Between 1 And 2 Cm: A Multicenter Experience

London, England (UroToday.com) Percutaneous nephrolithotomy (PCNL) is the golden standard surgical modality in the management of large kidney stones. Recently, we observed an increase in the use of PCNL for kidney stones. With raising popularity of PCNL procedures, there has been multiple modifications were proposed to the surgical techniques and instrumentation. Namely, miniPerc and UltraMiniPercs are most recent modified surgical techniques in the management kidney stones.

There are many retrospective studies demonstrating safety and efficacy of different mini versions of PCNL. Many studies have delineated and identified indications and contraindications for each procedure and this study attempts to prospectively evaluate the outcomes of three surgical techniques in a randomized fashion for lower calyceal stones between 1 and 2 cm to evaluate the efficacy and the safety of these procedures.

Study enrolled patients with a single lower calyceal stone between 1 and 2cm measured on preoperative computer tomography (CT) imaging. Patients were randomized into three groups: Group A: Patients treated with traditional prone PCNL; Group B: Patients treated with Mini-perc (MP); Group C: Patients treated with ultra-miniperc (UMP).

Follow up imaging consisted of CT imaging after and 3 months within the procedure. Stone free status was defined a negative or asymptomatic patients with stone fragments less than 3 mm in size. Authors compared perioperative and postoperative data including complications, blood loss, length of stay in the hospital and stone free rates.

A total of 132 consecutive patients were enrolled into the study between January 2014 and June 2016. Of these, 44 patients were randomized for group A, 47 for group B and 41 for group C. There was no significant difference in stone size among the groups (p=0.34). Regarding the primary outcome of the study, the overall stone free rate was 86.3% for group A, 82.9% for group B and 78.0 % for group C. These results are slightly lower than that average indicated in the current literature. Given the small size of stones included in the study (1-2cm), stone free rates are expected to be slightly better.

Patients who were identified to have a residual stone were scheduled for the secondary procedure. The retreatment rate was significantly higher in group C compared to the other two groups, 12.1% (p<0.05).

Complications are very important in any new surgical procedure. The complication rate in this study was 13.6%, 4.2% and 2.4% respectively for group A, B and C. There was no significant statistical difference but group A seems to have a clinically significantly highly complications compared to other group. One of the limitation of the presentation was that complications were not categorized according to the Clavien grade, which makes it challenging to assess the degree of complications.

In conclusion, authors reported that the standard PCNL and MiniPerc were more effective than UMP to obtain a better stone free rate in patients undergoing percutnaoues stone removal with 1 -2 cm in size. There were no significant differences in auxiliary and re-treatment rates among the groups. Standard PCNL was associated with more complications, and again it is hard to assess the type of complications due to the lack of standardized methods in this presentation.

Speaker(s): Dr. Maruccia, MD

Authors: Maruccia S.1, Sanguedolce F.2, Casellato S.1, Dal Piaz O.3, Montanari E.4, Pummer K.3, Verze P.5, Mirone V.5, Taverna G.6, Romero Otero J.7, Bozzini G.6

Institution(s): 1Istituti Clinici Zucchi, Dept. of Urology, Monza, Italy, 2Northampton General Hospital, Dept. of Urology, London, United Kingdom, 3Graz General Hospital, Dept. of Urology, Graz, Austria, 4Ospedale Policlinico, Dept. of Urology, Milan, Italy, 5Università Federico II, Dept. of Urology, Naples, Italy, 6Humanitas Mater Domini, Dept. of Urology, Castellanza, Italy, 7Hospital 12 De Octubre, Dept. of Urology, Madrid, Spain

at the #EAU17 - March 24-28, 2017- London, England