Super‐mini percutaneous nephrolithotomy ( SMP ): a new concept in technique and instrumentation

作者：Guohua Zeng, Shawpong Wan, Zhijian Zhao, Jianguo Zhu, Aierken Tuerxun, Chao Song, Liang Zhong, Ming Liu, Kewei Xu, Hulin Li, Zhiqiang Jiang, Sanjay Khadgi, Shashi Kiran Pal, Jianjun Liu, Guoxi Zhang, Yongda Liu, Wenqi Wu, Wenzhong Chen, Kemal Sarıca · 发表于：British Journal of Urology · 年份：2015 · DOI：10.1111/bju.13242 · 被引用次数：131 · 研究领域：Kidney Stones and Urolithiasis Treatments、Dialysis and Renal Disease Management、Gallbladder and Bile Duct Disorders

OBJECTIVE: To present a novel miniature endoscopic system designed to improve the safety and efficacy of percutaneous nephrolithotomy, named the 'super-mini percutaneous nephrolithotomy' (SMP). PATIENTS AND METHODS: The endoscopic system consists of a 7-F nephroscope with enhanced irrigation and a modified 10-14 F access sheath with a suction-evacuation function. This system was tested in patients with renal stones of <2.5 cm, in a multicentre prospective non-randomised clinical trial. In all, 146 patients were accrued in 14 centres. Nephrostomy tract dilatation was carried out to 10-14 F. The lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. A nephrostomy tube or JJ stent was placed only if clinically indicated. RESULTS: SMP was completed successfully in 141 of 146 patients. Five patients required conversion to larger nephrostomy tracts. The mean (sd) stone size was 2.2 (0.6) cm and the mean operative duration was 45.6 min. The initial stone-free rate (SFR) was 90.1%. The SFR at the 3-month follow-up was 95.8%. Three patients required auxiliary procedures for residual stones. Complications occurred in 12.8% of the patients, all of which were Clavien grade ≤II and no transfusions were needed. In all, 72.3% of the patients did not require any kind of catheter, while 19.8% had JJ stents and 5.7% had nephrostomy tubes placed. The mean hospital stay was 2.1 days. CONCLUSIONS: SMP is a safe and effective treatment for renal stones of <2.5 cm. SMP ma...