Micro-Percutaneous Nephrolithotomy for Renal Stones, Outcomes and Learning Curve - Beyond the Abstract

Recently the paper “Micro-percutaneous Nephrolithotomy (Microperc) for Renal Stones, Outcomes and Learning Curve” by Michel et al. was published in Progrès en Urologie which is the official journal of the Association Française d’Urologie (AFU) exploring a minimally invasive percutaneous technique in the treatment of kidney stones.

Micro-percutaneous nephrolithotomy (PCNL) also called MicroPerc® was first described by Dr. Janak Desai in 2011 and consists of a reusable flexible microfiber optic with a diameter of 0.9 mm in addition to a single-use kit that contained: an access sheath of 4.85 ch external diameter, its inner needle with stylet, a three-way connector for irrigation, and a laser fiber (230m).

We report the early experience of two institutions, the Assistance Publique/Hopitaux de Marseille and the Hôpital Privé de Provence, in the treatment of kidney stones <2.5cm with MicroPerc®. The learning curve was short and resulted in stone-free and morbidity rates that are usual with retrograde intrarenal surgery (RIRS).

We believe MicroPerc® is an interesting technique in the treatment of nephrolithiasis with complex access including kidney stones in patients with urinary diversion, caliceal diverticulum, and lower pole kidney stones that cannot be reached by RIRS.

At a University Hospital Department of Urology involved in the management of neurogenic bladder with various urinary diversion, MicroPerc® proved to be a minimal invasive technic as an alternative to standard PCNL or RIRS. In patients with lower pole kidney stones, MicroPerc® proved to be feasible in a one-day care unit with operating time similar to RIRS.

In conclusion, MicroPerc® could be complementary to RIRS considering its low morbidity, the feasibility in ambulatory cases, and the rapid shortening of operating time even at the beginning of the experience.

Written by: Romain Boissier, MD, PhD, FEBU, Consultant Urologist, Department of Urology and Kidney Transplantation, La Conception University Hospital, Aix-Marseille University, Assistance Publique/Hopitaux de Marseille, Marseille, France, Twitter: @R_Boissier