The role of micro-percutaneous nephrolithotripsy in the treatment of kidney stones

Protoshchak V.V., Orlov D.N., Paronnikov M.V., Karpushchenko E.G., Amdy R.E.

1) S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, St. Petersburg, Russia; 2) First St. Petersburg State Medical University named after Academician I.P. Pavlov of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

Background. Urolithiasis is one of the most common diseases of the urinary system, accounting for up to 50% of the capacity of urology departments in the Russian Federation. Modern minimally invasive technologies, including micro-percutaneous nephrolithotomy (PCNL), offer opportunities to optimize surgical strategy; however, the indications for its use remain controversial. Aim. To perform a comparative analysis of the outcomes of micro-percutaneous procedures versus other minimally invasive interventions in patients with kidney stones up to 2 cm in size. Materials and methods. The study included 172 patients with kidney stones up to 2 cm, divided into three groups: micro-PCNL (n=51), mini-PCNL (n=58), and retrograde intrarenal surgery (RIRS, n=63). A comparative assessment was performed of treatment efficacy, complication rates, additional interventions, and postoperative length of stay. The analysis also took into account stone location and size, as well as the anatomy of the renal collecting system according to the R. Takazawa classification (2018). Results. The overall treatment efficacy was 88.2% for micro-PCNL, 93.1% for mini-PCNL, and 87.3% for RIRS (p>0.05). No differences were found in complication rates or the need for additional interventions. In patients with stones ≤1 cm, micro-PCNL provided a shorter hospital stay than mini-PCNL – 3.4±0.5 versus 5.1±0.4 days (p=0.04). For lower calyceal stones, micro-PCNL demonstrated better efficacy than RIRS, 94.4% versus 70.4% (p=0.04). Analysis of the renal collecting system anatomy showed that the best outcomes of micro-PCNL were achieved in patients with a narrow (A1) and standard (A2) single pelvis, whereas in patients with a wide pelvis (A3) its efficacy decreased to 71.4% versus 94.7% and 95.2% for mini-PCNL and RIRS, respectively (p<0.05). Conclusions. Micro-PCNL is an effective and safe method for the treatment of kidney stones up to 2 cm, comparable to mini-PCNL and RIRS. Optimal outcomes of micro-percutaneous interventions are achieved in patients with stones ≤1 cm, stones located in the lower calyx, as well as in patients with a narrow or standard single renal pelvis.

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About the Authors

Corresponding author: D.N. Orlov – Head of the Urology Clinic, S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, St. Petersburg, Russia; e-mail: d.n.orlov@mail.ru

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